Plasma phospholipid fatty acid pattern in severe liver disease

Background/Aims: In acute liver failure the liver has to regenerate, which may increase the consumption of essential fatty acids. Nutritional support consists mainly of infusion of glucose. It is therefore possible that essential fatty acid deficiency may develop in such patients. Methods: Plasma phospholipid composition was studied in healthy controls (n=11), in patients with acute liver failure, (n=10), in patients with stable cirrhosis (n=7), and in patients with acute on chronic liver disease with hepatic encephalopathy (n=6). The influence of 2 days of fat-free diet followed by infusion of glucose was studied in five healthy controls. Results: The ratio between the sums of nonessential/essential fatty acids, (n-7+n-9)/(n-3+n-6), was higher in patients with acute liver failure (0.73±0.17) compared to healthy controls (0.35±0.06, p<0.001). The ratio was also higher in patients with acute on chronic liver disease (1.11±0.39) compared to patients with cirrhosis (0.61±0.18, p<0.01). These differences were mainly due to low levels of linoleic acid and high levels of oleic acid in the patients with acute liver failure and acute on chronic liver disease. Two days of fat-free diet followed by infusion of glucose did not change this ratio (0.40±0.04 vs. 0.47±0.05, NS) in healthy controls. The essential fatty acid deficiency indicator eicosatrienoic acid was detectable in 2 out of 11 controls, in 5/10 with acute liver failure, in 7/7 with cirrhosis, and in 6/7 with acute on chronic liver disease. Conclusion: Acute severe deterioration of liver function was associated with changes in the fatty acid composition of plasma phospholipids suggestive of essential fatty acid deficiency.