Vitamin E status of eight patients receiving total parenteral nutrition (TPN), including 10 IU of all-racemic α-tocopheryl acetate daily and Intralipid 20% (500 mL; 12 mg of RRR-α- and 92 mg of RRR-γ-tocopherols) two to three times per week for 69 ± 45 (mean ± SD) months was assessed by measuring plasma and adipose tissue tocopherol concentrations. Plasma α-tocopherols of TPN patients were similar to controls (17.5 ± 6.6 μmol/L vs 22.4 ± 5.1), whereas γ-tocopherols were significantly reduced (6.0 ± 3.1 vs 11.2 ± 3.6, p < 0.03). The adipose tissue α- and γ-tocopherol/triglycerides (TG) were similar (369 ± 215 nmol/mmol vs 452 ± 228, and 125 ± 102 vs 140 ± 130, respectively), but cholesterol/TG were increased in the TPN patients (7.8 ± 2.5 μmol/mmol vs 5.1 ± 3.5, p < 0.05), suggesting that adipose tissue was relatively TGdepleted and tocopherol/cholesterol measurements better reflect vitamin E status. The mean α-tocopherol/cholesterol ratios were significantly lower in the TPN patients than the controls (55 ± 36 vs 106 ± 63, p < 0.04). Thus, current vitamin E supplementation of TPN patients seems insufficient for maintenance of adequate tissue stores. (Journal of Parenteral and Enteral Nutrition 15:647-652, 1991)
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References
1.
Burton GW, Joyce A., Ingold KU: First proof that vitamin E is major lipid-soluble, chain-breaking antioxidant in human blood plasma. Lancet2:327, 1982
2.
Sokol RJ: Vitamin E deficiency and neurologic disease. Ann Rev Nutr8:351-373, 1988
3.
Bieri JGEvarts RP: Tocopherols and fatty acids inAmerican diets. J Am Diet Assoc62:147-151, 1973
4.
Kayden HJ: Vitamin E deficiency in patients with abetalipoproteinemia. IN Vitamine A. E und K. Klinische und physiologischchemische probleme . Kress. HFv, Blum KU (ed). F. K. Schattauer Verlag. Stuttgart. Germany. 301-308, 1967
5.
Miller RG, Davis CJF, Illingworth DR, et al: The neuropathy of abetalipoproteinemia. Neurology30:1286-1291, 1980
6.
Brin MF, Pedley TA, Emerson RG, et al: Electrophysiological features of abetalipoproteinemia: functional consequences of vitamin E deficiency. Neurology36:669-673, 1986
7.
Geller A., Gilles F., Schwachman H.: Degeneration of fasciculus gracilis in cystic fibrosis. Neurology27:158-187, 1977
8.
Elias E., Muller DPR, Scott J.: Association of spinocerebellar disorders with cystic fibrosis or chronic childhood cholestasis and very low serum vitamin E. Lancet2:1319-1321, 1981
9.
Rosenblum JL , Keating JP, Prensky AL, et al: A progressive neurologic syndrome in children with chronic liver disease. N Engl J Med304:503-508, 1981
10.
Gutcher GR, Lax AA, Farrell PM: Tocopherol isomers in intravenous lipid emulsions and resultant plasma concentrations . JPEN8:269-273, 1986
11.
Vandewoude MG, Vandewoude MFJ, DeLeeuw IH: Vitamin E status in patients on parenteral nutrition receiving intralipid. JPEN10:303-305, 1985
12.
Farrell PM: Vitamin E. Modern Nutrition in Health and Disease, Shils ME, Young VR (ed). Lea & Febiger, Philadelphia , 1988, pp 340-354
13.
Kelly FJ, Sutton GLJ: Plasma and red blood cell vitamin E status of patients on total parenteral nutrition. JPEN13:510-515, 1989
14.
Department of Foods and Nutrition, AMA: Multivitamin preparations for parenteral use. A statement by the Nutrition Advisory Group. JPEN3:258-262, 1979
15.
Shils ME, Baker H., Frank 0: Blood vitamin levels on long-term adult home total parenteral nutrition patients: The efficacy of the AMA-FDA parenteral multivitamin formulation . JPEN9:179-188, 1985
16.
Jeejeebhoy KN, Langer B., Tsallas G., et al: Total parenteral nutrition at home: Studies in patients surviving 4 months to 5 years. Gastroenterology71:943-953, 1976
17.
Traber MG, Kayden HJ: Tocopherol distribution and intracellular localization in human adipose tissue . Am J Clin Nutr46:488-495, 1987
18.
Kayden HJ, Hatam LJ, Traber MG: The measurement of nanograms of tocopherol from needle aspiration biopsies of adipose tissue: Normal and abetalipoproteinemic subjects. J Lipid Res24:652-656, 1983
19.
Kayden HJ: Tocopherol content of adipose tissue from vitamin E deficient humans. Biology of Vitamin E, Porter R, Whelan J (ed). Pittman Books, Ltd., London, 1983, pp 70-91
20.
Traber MG, Sokol RJ, Ringel SP, et al: Lack of tocopherol in peripheral nerves of vitamin E-deficient patients with peripheral neuropathy. N Engl J Med317:262-265, 1987
21.
Hatam LJ, Kayden HJ: A high-performance liquid chromatographic method for the determination of tocopherol in plasma and cellular elements of the blood. J Lipid Res20:639-645, 1979
22.
Traber MG, Kayden HJ: Preferential incorporation of α-tocopherol vs γ-tocopherol in human lipoproteins. Am J Clin Nutr49:517-526, 1989
23.
Baker H., Handelman GJ, Short S., et al: Comparison of plasma α-and γ-tocopherol levels following chronic oral administration of either all-rac-α-tocopheryl acetate or RRR-α-tocopheryl acetate in normal adult male subjects. Am J Clin Nutr43:382-387, 1986
24.
Handelman GJ , Machlin LJ, Fitch K., et al: Oral α-tocopherol supplements decrease plasma γ-tocopherol levels in humans. J Nutr115:807-813, 1985
25.
Schaefer EJ , Woo R., Kibata M., et al: Mobilization of triglyceride but not cholesterol or tocopherol from human adipocytes during weight reduction. Am J Clin Nutr37:749-754, 1983
26.
Vatassery GT , Brin MF, Fahn S., et al: Effect of high doses of dietary vitamin E upon the concentrations of vitamin E in several brain regions, plasma, liver, and adipose tissue of rats. J Neurochem51:621-623, 1988
27.
Dempsey DT, Mullen JL, Rombeau JL, et al: Treatment effects of parenteral vitamins in total parenteral nutrition patients. JPEN11:229-237, 1987
28.
Lemoyne M., Van Gossum A., Kurian R., et al: Breath pentane analysis as an index of lipid peroxidation: A functional test of vitamin E status. Am J Clin Nutr46:267-272, 1987
29.
Lemoyne M., Van Gossum A., Kurian R., et al: Plasma vitamin E and selenium and breath pentane in home parenteral nutrition patients. Am J Clin Nutr48:1310-1315, 1988
30.
Traber MG, Ingold KU, Burton GW, et al: Absorption and transport of deuterium-substituted 2R,4'R,8'R-α-tocopherol in human lipoproteins. Lipids23:791-797, 1988
31.
Traber MG, Burton GW, Ingold KU, et al: RRR- and SRR-α-tocopherols are secreted without discrimination in human chylomicrons, but RRR-α-tocopherol is preferentially secreted in very low-density lipoproteins. J Lipid Res31:675-685, 1990
32.
Bjørneboe A. , Bjørneboe G-EA , Drevon CA: Serum half-life, distribution, hepatic uptake and biliary excretion of α-tocopherol in rats. Biochim Biophys Acta921:175-181, 1987
33.
Catignani GL , Bieri JG: Rat liver α-tocopherol binding protein . Biochem Biophys Acta497:349-357, 1977
34.
Traber MG, Sokol RJ, Burton GW, et al: Impaired ability of patients with Familial Isolated Vitamin E Deficiency to incorporate α-tocopherol into lipoproteins secreted by the liver. J Clin Invest85:397-407, 1990
35.
Traber MG, Kayden HJ: Vitamin E is delivered to cells via the high affinity receptor for low density lipoprotein. Am J Clin Nutr40:747-751, 1984
36.
Traber MG, Olivecrona T., Kayden HJ: Bovine milk lipoprotein lipase transfers tocopherol to human fibroblasts during triglyceride hydrolysis in vitro. J Clin Invest75:1729-1734, 1985
37.
Traber M., Rudel L., Burton G., et al: Nascent VLDL from liver perfusions of cynomolgus monkeys are preferentially enriched in RRR-compared from SRR-α tocopherol. Studies using deuterated tocopherols. J Lipid Res31:687-694, 1990
