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Mark Puder - One of the best experts on this subject based on the ideXlab platform.
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Essential Fatty Acid status in surgical infants receiving parenteral nutrition with a composite lipid emulsion a case series
Journal of Parenteral and Enteral Nutrition, 2019Co-Authors: Kathleen M. Gura, Mark Puder, Alexandra N Carey, Coral Rudie, Paul Mitchell, Bram P RaphaelAbstract:: Infants requiring prolonged parenteral nutrition (PN) may receive intravenous (IV) lipid in the form of soybean oil, fish oil, or a composite lipid emulsion (CLE) (i.e., SMOFlipid®). Soybean oil lipid-dose restriction is a popular method of treating and reducing the risk of intestinal failure-associated liver disease (IFALD) that may influence dosing strategies of other IV fat emulsions. Here we present 4 infants receiving PN with SMOFlipid® as their IV lipid source and examine trends in Essential Fatty-Acid status, triglycerides, and dosing strategy. The infants on restricted doses of CLE developed biochemical Essential Fatty-Acid deficiency (EFAD) that resolved with a dosage increase or by transition to a pure fish-oil lipid emulsion. Three of the 4 infants originally prescribed CLE were diagnosed with IFALD and started a pure fish-oil lipid emulsion after treatable causes of cholestasis were excluded. One of the 4 infants presented with hypertriglyceridemia that resolved upon transition to pure fish-oil lipid emulsion. Misapplication of lipid restriction protocols to CLE regimens render infants at risk for EFAD. CLE should be dosed within recommended ranges to prevent EFAD. Restricted protocols warrant close monitoring of Essential Fatty-Acid status in infants receiving prolonged PN, particularly in those with minimal or no enteral intake. Hypertriglyceridemia and cholestasis are known adverse effects of CLE and require monitoring.
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the effect of varying ratios of docosahexaenoic Acid and arachidonic Acid in the prevention and reversal of biochemical Essential Fatty Acid deficiency in a murine model
Metabolism-clinical and Experimental, 2013Co-Authors: Erica M. Fallon, Bruce R. Bistrian, Jonathan A. Meisel, Vincent E. De Meijer, Kathleen M. Gura, Vania Nosé, Brian T Kalish, Amy Pan, Mark PuderAbstract:Objective Essential Fatty Acids (EFA) are necessary for growth, development, and biological function, and must be acquired through the diet. While linoleic Acid (LA) and alpha-linolenic Acid (ALA) have been considered the true EFAs, we previously demonstrated that docosahexaenoic Acid (DHA) and arachidonic Acid (AA) taken together as the sole source of dietary Fatty Acids can prevent biochemical Essential Fatty Acid deficiency (EFAD). This study evaluates the effect of varying dietary ratios of DHA:AA in the prevention and reversal of biochemical EFAD in a murine model.
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DOCOSAHEXAENOIC Acid AND ARACHIDONIC Acid PREVENT Essential Fatty Acid DEFICIENCY AND HEPATIC STEATOSIS
Journal of Parenteral and Enteral Nutrition, 2011Co-Authors: Jonathan A. Meisel, Bruce R. Bistrian, Vincent E. De Meijer, Erica M. Fallon, Kathleen M. Gura, Vania Nosé, Mark PuderAbstract:OBJECTIVES Essential Fatty Acids are important for growth, development, and physiologic function. α-Linolenic Acid and linoleic Acid are the precursors of docosahexaenoic and arachidonic Acid, respectively, and have traditionally been considered the Essential Fatty Acids. However, the authors hypothesized that docosahexaenoic Acid and arachidonic Acid can function as the Essential Fatty Acids. METHODS Using a murine model of Essential Fatty Acid deficiency and consequent hepatic steatosis, the authors provided mice with varying amounts of docosahexaenoic and arachidonic Acids to determine whether exclusive supplementation of docosahexaenoic and arachidonic Acids could prevent Essential Fatty Acid deficiency and inhibit or attenuate hepatic steatosis. RESULTS Mice supplemented with docosahexaenoic and arachidonic Acids at 2.1% or 4.2% of their calories for 19 days had normal liver histology and no biochemical evidence of Essential Fatty Acid deficiency, which persisted when observed after 9 weeks. CONCLUSION Supplementation of sufficient amounts of docosahexaenoic and arachidonic Acids alone without α-linolenic and linoleic Acids meets Essential Fatty Acid requirements and prevents hepatic steatosis in a murine model.
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parenteral fish oil as monotherapy prevents Essential Fatty Acid deficiency in parenteral nutrition dependent patients
Journal of Pediatric Gastroenterology and Nutrition, 2010Co-Authors: Vincent E. De Meijer, Jonathan A. Meisel, Kathleen M. Gura, Hau D Le, Mark PuderAbstract:Objective The use of fish oil-based emulsions as the sole source of fat for patients receiving parenteral nutrition (PN) has raised concerns for the development of Essential Fatty Acid deficiency (EFAD), hindering its adoption into clinical practice. The purpose of this study was to examine Fatty Acid profiles of patients receiving no enteral calories, while completely dependent on PN and an intravenous fish oil-based lipid emulsion, for onset of EFAD and maintenance of growth.
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parenteral fish oil as monotherapy prevents Essential Fatty Acid deficiency in parenteral nutrition dependent patients
Journal of Pediatric Gastroenterology and Nutrition, 2010Co-Authors: Vincent E. De Meijer, Jonathan A. Meisel, Kathleen M. Gura, Mark PuderAbstract:Objective The use of fish oil-based emulsions as the sole source of fat for patients receiving parenteral nutrition (PN) has raised concerns for the development of Essential Fatty Acid deficiency (EFAD), hindering its adoption into clinical practice. The purpose of this study was to examine Fatty Acid profiles of patients receiving no enteral calories, while completely dependent on PN and an intravenous fish oil-based lipid emulsion, for onset of EFAD and maintenance of growth.
Kathleen M. Gura - One of the best experts on this subject based on the ideXlab platform.
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Essential Fatty Acid status in surgical infants receiving parenteral nutrition with a composite lipid emulsion a case series
Journal of Parenteral and Enteral Nutrition, 2019Co-Authors: Kathleen M. Gura, Mark Puder, Alexandra N Carey, Coral Rudie, Paul Mitchell, Bram P RaphaelAbstract:: Infants requiring prolonged parenteral nutrition (PN) may receive intravenous (IV) lipid in the form of soybean oil, fish oil, or a composite lipid emulsion (CLE) (i.e., SMOFlipid®). Soybean oil lipid-dose restriction is a popular method of treating and reducing the risk of intestinal failure-associated liver disease (IFALD) that may influence dosing strategies of other IV fat emulsions. Here we present 4 infants receiving PN with SMOFlipid® as their IV lipid source and examine trends in Essential Fatty-Acid status, triglycerides, and dosing strategy. The infants on restricted doses of CLE developed biochemical Essential Fatty-Acid deficiency (EFAD) that resolved with a dosage increase or by transition to a pure fish-oil lipid emulsion. Three of the 4 infants originally prescribed CLE were diagnosed with IFALD and started a pure fish-oil lipid emulsion after treatable causes of cholestasis were excluded. One of the 4 infants presented with hypertriglyceridemia that resolved upon transition to pure fish-oil lipid emulsion. Misapplication of lipid restriction protocols to CLE regimens render infants at risk for EFAD. CLE should be dosed within recommended ranges to prevent EFAD. Restricted protocols warrant close monitoring of Essential Fatty-Acid status in infants receiving prolonged PN, particularly in those with minimal or no enteral intake. Hypertriglyceridemia and cholestasis are known adverse effects of CLE and require monitoring.
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the effect of varying ratios of docosahexaenoic Acid and arachidonic Acid in the prevention and reversal of biochemical Essential Fatty Acid deficiency in a murine model
Metabolism-clinical and Experimental, 2013Co-Authors: Erica M. Fallon, Bruce R. Bistrian, Jonathan A. Meisel, Vincent E. De Meijer, Kathleen M. Gura, Vania Nosé, Brian T Kalish, Amy Pan, Mark PuderAbstract:Objective Essential Fatty Acids (EFA) are necessary for growth, development, and biological function, and must be acquired through the diet. While linoleic Acid (LA) and alpha-linolenic Acid (ALA) have been considered the true EFAs, we previously demonstrated that docosahexaenoic Acid (DHA) and arachidonic Acid (AA) taken together as the sole source of dietary Fatty Acids can prevent biochemical Essential Fatty Acid deficiency (EFAD). This study evaluates the effect of varying dietary ratios of DHA:AA in the prevention and reversal of biochemical EFAD in a murine model.
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DOCOSAHEXAENOIC Acid AND ARACHIDONIC Acid PREVENT Essential Fatty Acid DEFICIENCY AND HEPATIC STEATOSIS
Journal of Parenteral and Enteral Nutrition, 2011Co-Authors: Jonathan A. Meisel, Bruce R. Bistrian, Vincent E. De Meijer, Erica M. Fallon, Kathleen M. Gura, Vania Nosé, Mark PuderAbstract:OBJECTIVES Essential Fatty Acids are important for growth, development, and physiologic function. α-Linolenic Acid and linoleic Acid are the precursors of docosahexaenoic and arachidonic Acid, respectively, and have traditionally been considered the Essential Fatty Acids. However, the authors hypothesized that docosahexaenoic Acid and arachidonic Acid can function as the Essential Fatty Acids. METHODS Using a murine model of Essential Fatty Acid deficiency and consequent hepatic steatosis, the authors provided mice with varying amounts of docosahexaenoic and arachidonic Acids to determine whether exclusive supplementation of docosahexaenoic and arachidonic Acids could prevent Essential Fatty Acid deficiency and inhibit or attenuate hepatic steatosis. RESULTS Mice supplemented with docosahexaenoic and arachidonic Acids at 2.1% or 4.2% of their calories for 19 days had normal liver histology and no biochemical evidence of Essential Fatty Acid deficiency, which persisted when observed after 9 weeks. CONCLUSION Supplementation of sufficient amounts of docosahexaenoic and arachidonic Acids alone without α-linolenic and linoleic Acids meets Essential Fatty Acid requirements and prevents hepatic steatosis in a murine model.
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parenteral fish oil as monotherapy prevents Essential Fatty Acid deficiency in parenteral nutrition dependent patients
Journal of Pediatric Gastroenterology and Nutrition, 2010Co-Authors: Vincent E. De Meijer, Jonathan A. Meisel, Kathleen M. Gura, Hau D Le, Mark PuderAbstract:Objective The use of fish oil-based emulsions as the sole source of fat for patients receiving parenteral nutrition (PN) has raised concerns for the development of Essential Fatty Acid deficiency (EFAD), hindering its adoption into clinical practice. The purpose of this study was to examine Fatty Acid profiles of patients receiving no enteral calories, while completely dependent on PN and an intravenous fish oil-based lipid emulsion, for onset of EFAD and maintenance of growth.
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parenteral fish oil as monotherapy prevents Essential Fatty Acid deficiency in parenteral nutrition dependent patients
Journal of Pediatric Gastroenterology and Nutrition, 2010Co-Authors: Vincent E. De Meijer, Jonathan A. Meisel, Kathleen M. Gura, Mark PuderAbstract:Objective The use of fish oil-based emulsions as the sole source of fat for patients receiving parenteral nutrition (PN) has raised concerns for the development of Essential Fatty Acid deficiency (EFAD), hindering its adoption into clinical practice. The purpose of this study was to examine Fatty Acid profiles of patients receiving no enteral calories, while completely dependent on PN and an intravenous fish oil-based lipid emulsion, for onset of EFAD and maintenance of growth.
Bruce R. Bistrian - One of the best experts on this subject based on the ideXlab platform.
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Essential Fatty Acid deficiency in 2015 the impact of novel intravenous lipid emulsions
Journal of Parenteral and Enteral Nutrition, 2015Co-Authors: Leah Gramlich, Liisa Meddings, Cathy Alberda, Sanit Wichansawakun, Sarah Robbins, David F Driscoll, Bruce R. BistrianAbstract:The Fatty Acids, linoleic Acid (18:2ω-6) and α-linolenic Acid (18:3ω-3), are Essential to the human diet. When these Essential Fatty Acids are not provided in sufficient quantities, Essential Fatty Acid deficiency (EFAD) develops. This can be suggested clinically by abnormal liver function tests or biochemically by an elevated Mead Acid and reduced linoleic Acid and arachidonic Acid level, which is manifested as an elevated triene/tetraene ratio of Mead Acid/arachidonic Acid. Clinical features of EFAD may present later. With the introduction of novel intravenous (IV) lipid emulsions in North America, the proportion of Fatty Acids provided, particularly the Essential Fatty Acids, varies substantially. We describe a case series of 3 complicated obese patients who were administered parenteral nutrition (PN), primarily using ClinOleic 20%, an olive oil-based lipid emulsion with reduced amounts of the Essential Fatty Acids, linoleic and α-linolenic, compared with more conventional soybean oil emulsions throughout their hospital admission. Essential Fatty Acid profiles were obtained for each of these patients to investigate EFAD as a potential cause of abnormal liver enzymes. Although the profiles revealed reduced linoleic Acid and elevated Mead Acid levels, this was not indicative of the development of Essential Fatty Acid deficiency, as reflected in the more definitive measure of triene/tetraene ratio. Instead, although the serum Fatty Acid panel reflected the markedly lower but still adequate dietary linoleic Acid content and greatly increased oleic Acid content in the parenteral lipid emulsion, the triene/tetraene ratio remained well below the level, indicating EFAD in each of these patients. The availability and use of new IV lipid emulsions in PN should encourage the clinician to review lipid metabolism based on the quantity of Fatty Acids provided in specific parenteral lipid emulsions and the expected impact of these lipid emulsions (with quite different Fatty Acid composition) on measured Fatty Acid profiles.
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the effect of varying ratios of docosahexaenoic Acid and arachidonic Acid in the prevention and reversal of biochemical Essential Fatty Acid deficiency in a murine model
Metabolism-clinical and Experimental, 2013Co-Authors: Erica M. Fallon, Bruce R. Bistrian, Jonathan A. Meisel, Vincent E. De Meijer, Kathleen M. Gura, Vania Nosé, Brian T Kalish, Amy Pan, Mark PuderAbstract:Objective Essential Fatty Acids (EFA) are necessary for growth, development, and biological function, and must be acquired through the diet. While linoleic Acid (LA) and alpha-linolenic Acid (ALA) have been considered the true EFAs, we previously demonstrated that docosahexaenoic Acid (DHA) and arachidonic Acid (AA) taken together as the sole source of dietary Fatty Acids can prevent biochemical Essential Fatty Acid deficiency (EFAD). This study evaluates the effect of varying dietary ratios of DHA:AA in the prevention and reversal of biochemical EFAD in a murine model.
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DOCOSAHEXAENOIC Acid AND ARACHIDONIC Acid PREVENT Essential Fatty Acid DEFICIENCY AND HEPATIC STEATOSIS
Journal of Parenteral and Enteral Nutrition, 2011Co-Authors: Jonathan A. Meisel, Bruce R. Bistrian, Vincent E. De Meijer, Erica M. Fallon, Kathleen M. Gura, Vania Nosé, Mark PuderAbstract:OBJECTIVES Essential Fatty Acids are important for growth, development, and physiologic function. α-Linolenic Acid and linoleic Acid are the precursors of docosahexaenoic and arachidonic Acid, respectively, and have traditionally been considered the Essential Fatty Acids. However, the authors hypothesized that docosahexaenoic Acid and arachidonic Acid can function as the Essential Fatty Acids. METHODS Using a murine model of Essential Fatty Acid deficiency and consequent hepatic steatosis, the authors provided mice with varying amounts of docosahexaenoic and arachidonic Acids to determine whether exclusive supplementation of docosahexaenoic and arachidonic Acids could prevent Essential Fatty Acid deficiency and inhibit or attenuate hepatic steatosis. RESULTS Mice supplemented with docosahexaenoic and arachidonic Acids at 2.1% or 4.2% of their calories for 19 days had normal liver histology and no biochemical evidence of Essential Fatty Acid deficiency, which persisted when observed after 9 weeks. CONCLUSION Supplementation of sufficient amounts of docosahexaenoic and arachidonic Acids alone without α-linolenic and linoleic Acids meets Essential Fatty Acid requirements and prevents hepatic steatosis in a murine model.
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fish oil prevents Essential Fatty Acid deficiency and enhances growth clinical and biochemical implications
Metabolism-clinical and Experimental, 2008Co-Authors: Robert Strijbosch, Bruce R. Bistrian, Kathleen M. Gura, Sang Lee, Danielle A Arsenault, Charlotte Andersson, Mark PuderAbstract:Fish oil, a rich source of omega-3 Fatty Acids, has never been used as the sole source of lipid in clinical practice for fear of development of Essential Fatty Acid deficiency, as it lacks the believed requisite levels of linoleic Acid, an omega-6 Fatty Acid. The objectives of this study were to establish biochemical standards for fish oil as the sole fat and to test the hypothesis that fish oil contains adequate amounts of omega-6 Fatty Acids to prevent Essential Fatty Acid deficiency. Forty mice were divided into 2 groups that were either pair fed or allowed to eat ad libitum. In each group, 4 subgroups of 5 mice were fed 1%, 5%, and 10% fish oil diets by weight or a control soybean diet for 9 weeks. Blood was collected at 4 time points, and Fatty Acid analysis was performed. Food intake and weight status were monitored. All groups but the pair-fed 1% fish oil group gained weight, and the 5% fish oil group showed the highest caloric efficiency in both pair-fed and ad libitum groups. Fatty Acid profiles for the 1% fish oil group displayed clear Essential Fatty Acid deficiency, 5% fish oil appeared marginal, and 10% and soybean oil diets were found to prevent Essential Fatty Acid deficiency. Fish oil enhances growth through higher caloric efficiency. We established a total omega-6 Fatty Acid requirement of between 0.30% and 0.56% of dietary energy, approximately half of the conventionally believed 1% as linoleic Acid. This can presumably be attributed to the fact that fish oil contains not only a small amount of linoleic Acid, but also arachidonic Acid, which has greater efficiency to meet omega-6 Fatty Acid requirements.
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Disturbances in Essential Fatty Acid Metabolism in Patients Receiving Long-Term Home Parenteral Nutrition
Digestive Diseases and Sciences, 2002Co-Authors: Pei-ra Ling, Mario Ollero, Lalita Khaodhiar, Karen Mccowen, Mary Keane-ellison, Ann Thibault, Nicholas Tawa, Bruce R. BistrianAbstract:Patients receiving home total parenteral nutrition (HTPN) are at risk for the development of Essential Fatty Acid deficiency (EFAD). This study examined the Essential Fatty Acid status of patients on long-term HTPN for gut failure. Serum phospholipid and triglyceride Fatty Acids were measured in 11 patients and 10 healthy volunteers. Patients had similar levels of linoleic Acid (18:2w6) in serum triglyceride Fatty Acids but significantly lower levels of 18:2w6 in serum phospholipids compared to controls. Although there was accumulation of Mead Acid (20:3w9) in both Fatty Acid fractions, the ratio of 20:3w9 to arachidonic Acid (20:4w6) remained less than 0.2, reflecting an adequate Essential Fatty Acid status in these patients. There were, however, substantial increases in 20:4w6 content in both triglyceride and phospholipid fractions in serum despite the lower levels of 18:2w6 in serum phospholipids, suggesting that an accelerated hepatic conversion of 18:2w6 to 20:4w6 occurs in HTPN patients, as well as the 20-carbon members of w3 (20:3w3) and w9 (20:3w9) families. The determination of optimal parenteral fat intakes should be investigated further as important priority in patients receiving long term HTPN.
Takayuki Y Nara - One of the best experts on this subject based on the ideXlab platform.
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Essential Fatty Acid synthesis and its regulation in mammals
Prostaglandins Leukotrienes and Essential Fatty Acids, 2003Co-Authors: Manabu T Nakamura, Takayuki Y NaraAbstract:The tissue content of highly unsaturated Fatty Acids (HUFA) such as arachidonic Acid and docosahexaenoic Acid is maintained in a narrow range by feedback regulation of synthesis. Delta-6 desaturase (D6D) catalyzes the first and rate-limiting step of the HUFA synthesis. Recent identification of a human case of D6D deficiency underscores the importance of this pathway. Sterol regulatory element binding protein-1c (SREBP-1c) is a key transcription factor that activates transcription of genes involved with Fatty Acid synthesis. We recently identified sterol regulatory element (SRE) that is required for activation of the human D6D gene by SREBP-1c. Moreover, the same SRE also mediates the suppression of the D6D gene by HUFA. The identification of SREBP-1c as a key regulator of D6D suggests that the major physiological function of SREBP-1c in liver may be the regulation of phospholipid synthesis rather than triglyceride synthesis. Peroxisome proliferators (PP) induce Fatty Acid oxidation enzymes and desaturases in rodent liver. However, the induction of desaturases by PP is slower than the induction of oxidation enzymes. This delayed induction may be a compensatory reaction to the increased demand of HUFA caused by increased HUFA oxidation and peroxisome proliferation in PP administration. Recent studies have demonstrated a critical role of peroxisomal β-oxidation in DHA synthesis, and identified acyl CoA oxidase and D-bifunctional protein as the key enzymes.
Vincent E. De Meijer - One of the best experts on this subject based on the ideXlab platform.
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the effect of varying ratios of docosahexaenoic Acid and arachidonic Acid in the prevention and reversal of biochemical Essential Fatty Acid deficiency in a murine model
Metabolism-clinical and Experimental, 2013Co-Authors: Erica M. Fallon, Bruce R. Bistrian, Jonathan A. Meisel, Vincent E. De Meijer, Kathleen M. Gura, Vania Nosé, Brian T Kalish, Amy Pan, Mark PuderAbstract:Objective Essential Fatty Acids (EFA) are necessary for growth, development, and biological function, and must be acquired through the diet. While linoleic Acid (LA) and alpha-linolenic Acid (ALA) have been considered the true EFAs, we previously demonstrated that docosahexaenoic Acid (DHA) and arachidonic Acid (AA) taken together as the sole source of dietary Fatty Acids can prevent biochemical Essential Fatty Acid deficiency (EFAD). This study evaluates the effect of varying dietary ratios of DHA:AA in the prevention and reversal of biochemical EFAD in a murine model.
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DOCOSAHEXAENOIC Acid AND ARACHIDONIC Acid PREVENT Essential Fatty Acid DEFICIENCY AND HEPATIC STEATOSIS
Journal of Parenteral and Enteral Nutrition, 2011Co-Authors: Jonathan A. Meisel, Bruce R. Bistrian, Vincent E. De Meijer, Erica M. Fallon, Kathleen M. Gura, Vania Nosé, Mark PuderAbstract:OBJECTIVES Essential Fatty Acids are important for growth, development, and physiologic function. α-Linolenic Acid and linoleic Acid are the precursors of docosahexaenoic and arachidonic Acid, respectively, and have traditionally been considered the Essential Fatty Acids. However, the authors hypothesized that docosahexaenoic Acid and arachidonic Acid can function as the Essential Fatty Acids. METHODS Using a murine model of Essential Fatty Acid deficiency and consequent hepatic steatosis, the authors provided mice with varying amounts of docosahexaenoic and arachidonic Acids to determine whether exclusive supplementation of docosahexaenoic and arachidonic Acids could prevent Essential Fatty Acid deficiency and inhibit or attenuate hepatic steatosis. RESULTS Mice supplemented with docosahexaenoic and arachidonic Acids at 2.1% or 4.2% of their calories for 19 days had normal liver histology and no biochemical evidence of Essential Fatty Acid deficiency, which persisted when observed after 9 weeks. CONCLUSION Supplementation of sufficient amounts of docosahexaenoic and arachidonic Acids alone without α-linolenic and linoleic Acids meets Essential Fatty Acid requirements and prevents hepatic steatosis in a murine model.
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parenteral fish oil as monotherapy prevents Essential Fatty Acid deficiency in parenteral nutrition dependent patients
Journal of Pediatric Gastroenterology and Nutrition, 2010Co-Authors: Vincent E. De Meijer, Jonathan A. Meisel, Kathleen M. Gura, Hau D Le, Mark PuderAbstract:Objective The use of fish oil-based emulsions as the sole source of fat for patients receiving parenteral nutrition (PN) has raised concerns for the development of Essential Fatty Acid deficiency (EFAD), hindering its adoption into clinical practice. The purpose of this study was to examine Fatty Acid profiles of patients receiving no enteral calories, while completely dependent on PN and an intravenous fish oil-based lipid emulsion, for onset of EFAD and maintenance of growth.
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parenteral fish oil as monotherapy prevents Essential Fatty Acid deficiency in parenteral nutrition dependent patients
Journal of Pediatric Gastroenterology and Nutrition, 2010Co-Authors: Vincent E. De Meijer, Jonathan A. Meisel, Kathleen M. Gura, Mark PuderAbstract:Objective The use of fish oil-based emulsions as the sole source of fat for patients receiving parenteral nutrition (PN) has raised concerns for the development of Essential Fatty Acid deficiency (EFAD), hindering its adoption into clinical practice. The purpose of this study was to examine Fatty Acid profiles of patients receiving no enteral calories, while completely dependent on PN and an intravenous fish oil-based lipid emulsion, for onset of EFAD and maintenance of growth.