ESSENTIAL FATTY-ACID DEFICIENCY IN ADULTS RECEIVING TOTAL PARENTERAL NUTRITION

In 7 adult patients receiving fat-free total parenteral nutrition (TPN) for 4-8 wk, weekly determinations of plasma fatty acids and total plasma tocopherols were made. Patients (4) were deficient in essential fatty acids, as defined by triene:tetraene ratio < 0.4, at the end of the 2nd wk of TPN. By the end of the 3rd wk 6 patients were deficient and all 7 were deficient by the end of the 5th wk of TPN treatment. One patient who was deficient in both essential fatty acids and Zn developed a scaling, eczemoid dermatitis that disappeared within 3 wk after cessation of TPN and resumption of oral feedings containing both fat and Zn. After resumption of oral feedings by 3 patients, the triene:tetraene ratio returned to normal within 2 wk. The mean of total plasma tocopherols fell over a period of 7 wk and in 3 individuals, reached levels generally associated with deficiency. There were not any obvious clinical manifestations of vitamin E deficiency.