Essential fatty acid status and cognition in children with chronic intestinal failure

OBJECTIVES: Children with chronic intestinal failure (CIF) are at risk of cognitive delays, but the underlying mechanisms remain unclear. Essential fatty acid deficiency (EFAD) may impair brain development. Lipid restrictions in home parenteral nutrition (HPN) used to prevent intestinal failure-associated liver disease may increase EFAD risk. We assessed EFA status and cognitive functioning in children with CIF and examined associations with EFAD. METHODS: In this cross-sectional cohort study, children aged 4-17 years with CIF receiving HPN were included. EFAD was defined as a triene-to-tetraene ratio >0.007 with low linoleic and α-linolenic acid and elevated mead acid. Cognition was assessed using the Wechsler Intelligence Scale for Children (Fifth Edition) or Wechsler Preschool and Primary Scale of Intelligence (Fourth Edition); Full-Scale Intelligence Quotient (FSIQ) and index scores were compared with normative data and between EFAD and non-EFAD groups. EFA status was measured in erythrocyte membranes by gas chromatography. RESULTS: 17 of 23 eligible children participated (74%); 5 (29%) met EFAD criteria. Mean FSIQ was 90.7 ± 18.1 (p = 0.051 vs. normative mean). In children with EFAD, multiple cognitive domains were significantly lower than normative means. Compared with non-EFAD children, children with EFAD had a lower Cognitive Proficiency Index and Working Memory Index (CPI: 81.2 ± 6.3 vs. 103.8 ± 18.3, p = 0.018; WMI: 88.8 ± 9.9 vs. 108.0 ± 13.7, p = 0.013). CONCLUSIONS: EFAD was common in children with CIF and associated with lower working memory and processing efficiency. These findings support optimizing parenteral lipid provision to meet EFA requirements and considering EFAD screening. Larger prospective studies are needed to confirm these findings.