Hypothesis: vitamin E complements polyunsaturated fatty acids in essential fatty acid deficiency in cystic fibrosis

While several studies have demonstrated essential fatty acid (EFA) deficiency in plasma and tissue lipids of cystic fibrosis (CF) patients, the reasons for this deficiency are not well established. It is believed that reduced EFA intake, malabsorption of fat, altered desaturase/lipase activity and defective cystic fibrosis transmembrane conductance regulator (CFTR) altering utilisation of EFA in epithelial cells contribute to the development of EFA deficiency in CF. It is likely that increased metabolism of arachidonic acid to eicosanoids such as leukotrienes, thromboxane and prostaglandins may also be a contributing factor. Evidence is presented that elevated oxidative damage to EFA and impaired antioxidant defences, in particular vitamin E, may contribute to the development of EFA deficiency in CF. Furthermore, antioxidant supplementation in CF may improve EFA status.     

Paradoxical effects of essential fatty acid supplementation on lipid profiles and sweat electrolytes in cystic fibrosis

Supplements of evening primrose oil (Oenothera biennis), which contains at least 72% linoleic (18:2n-6) and 7% gamma-linolenic (18:3 n-6) acids (expressed as % fatty acid methyl esters) were given to sixteen cystic fibrosis patients for a period of 12 months. Clinical observations showed no significant changes in patients' weights or respiratory function throughout. Linoleic acid levels in plasma and erythrocyte membranes increased significantly during the first 6 months but this increase was not sustained at its initial level. After supplementation was discontinued reversion to baseline (low) levels occurred within 4 months. Levels of plasma prostaglandins (PG) and urinary PG metabolites varied among individuals over a wide range, and urinary PGF2 alpha metabolites fell during the supplementation. There was a significant fall in sweat sodium concentrations after 6 weeks of supplementation, but sweat chloride was unchanged. It is not known whether the effect of essential fatty acids on sweat Na+ reflects changes in cell membrane conformation or if there is a direct effect on Na+ pump activity.     

The deltaF508 mutation in the cystic fibrosis transmembrane conductance regulator alters control of essential fatty acid utilization in epithelial cells

Essential fatty acid (EFA) incorporation into phospholipid is influenced by chloride channels, suggesting that the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) may regulate aspects of EFA metabolism. The objective of this study was to determine whether the DeltaF508 mutation in the CFTR lowers 18:2(n-6) levels in phospholipid. Control cells, CF cells and CF cells transfected with the "normal" CFTR gene or the DeltaF508 CFTR gene were cultured for 3-5 d and used to determine [1-(14)C]18:2(n-6) incorporation into cell lipids. CF cells exhibited low 18:2(n-6) levels in phospholipid, reduced [1-(14)C]18:2(n-6) incorporation into phospholipid (50% of control) and greater [1-(14)C]18:2(n-6) incorporation into the triacylglycerol fraction (400% of control; P: < 0.05). Kinetic modeling of time course data for [1-(14)C]18:2(n-6) incorporation revealed a loss of metabolic control over the intracellular partitioning of 18:2(n-6) between phospholipid and triacylglycerol pools in CF cells. Expression of the normal CFTR gene in transfected CF cells increased chloride efflux and the incorporation of [1-(14)C]18:2(n-6) into phospholipid and triacylglycerol fractions. The increased incorporation of [1-(14)C]18:2(n-6) into phospholipid was attributed to significantly increased incorporation of [1-(14)C]18:2(n-6) into phosphatidylcholine and phosphatidylinositol. In CF cells expressing the defective DeltaF508 CFTR gene, conversion of [1-(14)C]18:2(n-6) to 20:4(n-6) by desaturation-chain elongation was 1.8-fold greater (P: < 0.05) than observed for CF cells transfected with the normal gene. The observations suggest that CF results in a defect in the utilization of 18:2(n-6), which is attributed in part to the defective CFTR.     

Neutrophil unsaturated fatty acid release by GM-CSF is impaired in cystic fibrosis

Dysregulated inflammation in cystic fibrosis (CF) is attributed to an altered production of inflammatory mediators derived from polyunsaturated lipids. In comparison to the arachidonic acid (AA) cascade, little is known about the modulation of docosahexaenoic acid (DHA) membrane release. We compared data on neutrophil DHA- and AA- release from both control (CT) and patients with CF using [³H]AA or [¹⁴C]DHA as a markers for, respectively, AA and DHA- release. Granulocyte-macrophage-colony stimulating factor stimulated DHA release from CT, but not CF, neutrophils. Comparison showed that both [¹⁴C]DHA and [³H]AA liberated after stimulation was higher in CT than in CF neutrophils. Since bioactive mediators derived from DHA are resolving factors and those derived from AA are both pro- and anti- inflammatory, these results suggest that CF is associated with a reduction of the release of PUFA-precursors of lipooxygenated resolving mediators. This leads to the hypothesis that defects in the resolving factors production could contribute to the inflammatory dysregulated processes in CF. Furthermore, the methodology used may help to improve knowledge on the regulation and resolution of inflammation.     

Essential fatty acid status and fluidity of plasma phospholipids in cystic fibrosis infants

The fatty acid (FA) patterns of cord serum phospholipids (PLs) were examined in 4 cystic fibrosis (CF) newborns, 8 non-CF siblings, and 22 normal control subjects. Plasma from 27 newly diagnosed CF infants and 38 normal infants aged less than 2 y were studied for comparison. CF cord-blood PLs had patterns similar to those of CF siblings and to normal newborns, but the pattern for CF did not shift toward adult patterns during infancy as did patterns for normal infants. CF infants at diagnosis exhibited a deficiency pattern in which 18: 2 omega 6, 20:4 omega 6, 22:4 omega 6, an omega 3 polyunsaturated fatty acids (PUFAs) were significantly subnormal and 18:3 omega 6, total saturated fatty acids, and total monounsaturated fatty acids were significantly elevated compared with normal infants. In PLs in CF infants, although mean chain length of FAs was low, mean melting point was elevated 2.4 degrees C and double-bond index was low (both P less than 0.001), implying a significantly lessened fluidity. Nutritional supplements of both omega 6 and omega 3 PUFAs are cated.     

Icosanoid synthesis as a functional measurement of essential fatty acid requirement.

To assess the need for postoperative vitamin supplements, intakes and nutritional status of thiamin (B1) and vitamin B6 were studied in 18 female gastroplasty patients who received a placebo or different levels of supplemental vitamins. Postoperative erythrocyte transketolase basal (BA) and thiamin pyrophosphate-stimulated (SA) activities and activity coefficients (AC) correlated significantly with B1 intake. Despite a decrease in apotransketolase, low thiamin intakes were associated with increased AC values during the first 3 months. With return to low B1 intakes following repletion during month 4, the AC values remained normal with low total activities. Both alanine (EALT) and aspartate (EAST) aminotransferase apoenzyme levels declined and AC values increased significantly during the first 3 months. Although the EALT-indices were more sensitive to changes in B6 intake than the EAST-indices, the EASTBA and SA correlated most consistently with the intake. Postoperative dietary intakes of both vitamins were inadequate for maintenance of normal activities of these erythrocyte enzymes. Although B1 intake of greater than or equal to 1.0 mg/day was adequate for maintenance of normal thiamin status in most subjects of this study, supplementation with greater than or equal to 1.5 mg/day is prudent even though it may not prevent the early postoperative loss of apotransketolase. Vitamin B6 intake at the current recommended dietary allowance (1.6 mg) was not adequate to maintain coenzyme saturation of the erythrocyte aminotransferases. Marginal intake of other nutrients may have affected the utilization of both thiamin and vitamin B6.     

Effect of methyl linoleate administration on phospholipid fatty acid composition and osmotic fragility of erythrocytes in essential fatty acid deficient rats

Methyl linoleate (18:2 omega 6) was administered to rats deficient in essential fatty acids (EFA) and the effects on osmotic fragility and lipid composition of their red blood cells were studied. Even if they remained deficient in omega-3 fatty acids, the fragile red cells of EFA-deficient rats were remarkably strengthened by the linoleate treatment. It is concluded that omega-3 fatty acids are not essential for the maintenance of cell membrane integrity in rats. Since the cholesterol/phospholipid ratio in red cells was lower in untreated than in treated rats, it is suggested that this factor might be responsible in part for the higher fragility of red cells in EFA-deficient rats. Despite the prolonged administration of overload quantities of methyl linoleate, the proportion of 18:2 omega 6 in the red blood cell phospholipids of treated rats was actually lower than that in rats fed a regular stock diet, while the relative content of other omega-6 fatty acids (20:4 omega 6, 22:4 omega 6, and 22:5 omega 6) increased. These results indicate that the metabolic processes of omega-6 fatty acids in treated rats were stimulated, probably as a result of the lack of competition from omega-3 fatty acids for the same enzyme systems.     

Effect of methyl linoleate administration on phospholipid fatty acid composition and osmotic fragility of erythrocytes in essential fatty acid deficient rats.

Methyl linoleate (18:2 omega 6) was administered to rats deficient in essential fatty acids (EFA) and the effects on osmotic fragility and lipid composition of their red blood cells were studied. Even if they remained deficient in omega-3 fatty acids, the fragile red cells of EFA-deficient rats were remarkably strengthened by the linoleate treatment. It is concluded that omega-3 fatty acids are not essential for the maintenance of cell membrane integrity in rats. Since the cholesterol/phospholipid ratio in red cells was lower in untreated than in treated rats, it is suggested that this factor might be responsible in part for the higher fragility of red cells in EFA-deficient rats. Despite the prolonged administration of overload quantities of methyl linoleate, the proportion of 18:2 omega 6 in the red blood cell phospholipids of treated rats was actually lower than that in rats fed a regular stock diet, while the relative content of other omega-6 fatty acids (20:4 omega 6, 22:4 omega 6, and 22:5 omega 6) increased. These results indicate that the metabolic processes of omega-6 fatty acids in treated rats were stimulated, probably as a result of the lack of competition from omega-3 fatty acids for the same enzyme systems.     

Stature as a prognostic factor in cystic fibrosis survival

OBJECTIVE/DESIGN: This study provides a longitudinal analysis of the National Cystic Fibrosis Patient Registry to determine if height-for-age percentile would be a useful predictor of survival. SUBJECTS: All patients were selected from the national registry (n = 19,000) maintained by the Cystic Fibrosis Foundation's 115 accredited Cystic Fibrosis Care Centers in the United States. Inclusion in our analysis required that subjects were born between 1980 and 1989; had a minimum of 4 records each; the subject was alive at age 7; and the subject had a recorded height measurement at age 7 to 8 (n = 2,773). STATISTICAL ANALYSIS: The Cox proportional hazards model was used to compare height-for-age with survival. We recorded whether a subject was less than the 5th National Center for Health Statistics (NCHS) percentile at age 5 and then in a separate analysis at age 7. Cohort effect was coded as "1" if they were born before 1982 and "0" otherwise. RESULTS: Stature is a significant prognostic indicator of survival. The relative hazard associated with height below the 5th NCHS percentile for age was significant for both males and females. In males at age 5 the relative hazard was 2.9, [95% confidence interval (CI) 1.23, 6.91; P < .02] and at age 7 it was 6.3 (95% CI 2.1, 18.8; P < .001). The relative hazard in females at age 5 was 4.3 (95% CI 2.4, 7.3; P < .0001) and at age 7 was 5.8 (95% CI 2.5, 13.1; P < .0001). APPLICATION: These highly significant relative hazard values strongly suggest that shorter patients are much more likely to die before taller patients. The dietetic professional should consider using height-for-age as an effective screening tool to identify patients at risk. Based on these data, short stature should not be considered benign to patients with cystic fibrosis. The CF team, clinicians, family, and patients need work together to maximize linear growth through medical and nutritional intervention.     

Changes in human plasma essential fatty acid levels as a result of administration of linoleic acid and gamma-linolenic acid

Administration of doses of linoleic acid (LA) up to 36 g/d in humans raised blood levels of linoleic acid but not of its metabolites. This is probably because the conversion of LA to gamma-linolenic acid (GLA) is slow and rate-limiting. We have found that administration of relatively small amounts of GLA, up to 360 mg/d, raises human blood levels of dihomogammalinolenic acid (DGLA) and arachidonic acid (AA).     

Serum phospholipid fatty acid profile and dietary intake in an adult Mediterranean population with cystic fibrosis

The relative importance of the usual diet in serum phospholipids in subjects with cystic fibrosis (CF) has been poorly studied. To compare the fatty acid profile in serum phospholipids from adult CF subjects with that of healthy subjects, and determine the role of the normal diet in this profile, we studied thirty-seven adult CF subjects with stable pulmonary disease and thirty-seven healthy controls matched for age, sex and nutritional status. A dietary questionnaire was obtained, anthropometric data were recorded, and the fatty acid profile measured by GLC. Compared with the controls, the percentages of myristic, palmitoleic and stearic acids and total MUFA were significantly higher in the CF group, and DHA, linoleic acid, total PUFA and n-6 fatty acids were significantly lower in the CF group. The CF subjects with worse pulmonary function and with pancreatic insufficiency had significantly lower levels of linoleic and n-6 fatty acids. The total energy intake was significantly higher in the CF subjects, although the energy distribution in the CF subjects and the controls was not different for the carbohydrates, lipids and proteins. No differences were detected in fat intake for MUFA (51 (SD 4) v. 52 (SD 4) %) or saturated fatty acids (33.5 (SD 5) v. 31.2 (SD 3.8) %), but the PUFA were slightly lower in the CF subjects (15.4 (SD 4.5) v. 17.4 (SD 4.2) %; P=0.02). The usual dietary intake of fatty acids by adult CF subjects does not appear to explain the difference in the fatty acid profile compared with controls. This suggests an abnormal fatty acid metabolism in CF subjects.     

Directed modification instead of normalization of fatty acid patterns in cystic fibrosis: an emerging concept

Fatty acid patterns divergent from controls have been described in patients with cystic fibrosis. The range of this divergence is very broad. In some patients the plasma fatty acid pattern is normal, others only have abnormalities of a few essential fatty acids, some have fatty acid deviations tending to a reduced essential fatty acid status or have overt essential fatty acid deficiency. In the past, several nutritional interventions were aimed at normalizing deviating fatty acid patterns. Over the years, biochemical findings have been reported that suggest that it may be more beneficial to change fatty acid status in a directed way rather than normalizing it.     

Role of linoleate as an essential fatty acid for the cat independent of arachidonate synthesis

To determine the essential fatty acid (EFA) requirements of the cat, specific pathogen-free kittens were fed either a linoleate-deficient diet or one of two diets containing 5% safflower seed oil (SSO) with or without 0.2% tuna oil. The diets were fed for 82-101 weeks beginning at 3 months of age. The results showed that linoleate is an essential fatty acid for the cat. Linoleate deficiency resulted in reduced feed efficiency (in males), high rates of transepidermal water loss, poor skin and coat condition, and fatty liver. These manifestations of EFA deficiency were prevented by SSO. Tuna oil had no additional effect. Analyses of the fatty acid composition of plasma, erythrocytes and liver lipids revealed that linoleate deficiency caused changes that were qualitatively, but not quantitatively similar to EFA deficiency in the rat. When SSO was provided, linoleate was elongated and desaturated at the delta 5 position to form 20:2n6 and 20:3(5,11,14). However, there was negligible conversion of linoleate to arachidonate. These results indicate that linoleate has specific functions as an EFA, independent of arachidonate synthesis and prostaglandin formation.     

Docosahexaenoic acid is superior to eicosapentaenoic acid as the essential fatty acid for growth of grouper, Epinephelus malabaricus.

Juvenile grouper (Epinephelus malabaricus) were fed seven experimental diets, one control diet and one reference diet for 12 wk to determine the dietary requirement of grouper for docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids. Each of the seven diets contained 1 g/100 g DHA and EPA in various combinations and 9 g/100 g tristearin. The control diet contained 1 g/100 g trilinolenin and trilinolein (3:1, wt/wt), and no supplemental EPA or DHA. The reference diet contained only natural oils from a mixture of cod liver oil, linseed oil and safflower oil at a ratio of 2:1:1 (wt/wt/wt). Significant differences (P < 0.05) in growth were observed among the dietary treatments but not in survival rate or relative liver weight. Only the diet with the highest DHA/EPA ratio (3:1) promoted significantly greater growth than the control diet. Purified EPA and DHA did not perform better in promoting growth than did the impure EPA and DHA oils. Enhanced growth was observed when the dietary DHA/EPA ratio was greater than 1, indicating that DHA was superior to EPA in promoting fish growth. Neutral lipid (NL) was the predominant lipid fraction (>70%) in both liver and muscle. Tissue NL/polar lipid did not differ among groups except the reference diet group that had a higher ratio (P < 0.05). DHA and EPA levels in the grouper tissues, especially muscle, were highly reflective of dietary levels of DHA and EPA, indicating that direct incorporation was likely. In addition, the 20:1(n-9), concentration in NL fractions seems to be an appropriate indicator of dietary essential fatty acid deficiency in grouper.