This report summarizes data on the availability of
essential fatty acids (EFAs) and their long-chain
polyunsaturated fatty acid (LCPUFA) metabolites in
protein-energy malnutrition (PEM), in human immunodeficiency virus-1 (HIV-1)
infection for which less information is available, and the combination of both PEM and HIV-1. The contribution of different EFAs and LCPUFAs to the
fatty-acid composition of plasma and erythrocyte membrane
lipids was found to be reduced in children with PEM in comparison with well-nourished children. In addition to limited dietary EFA supply, reduced bioconversion of EFAs to their respective LCPUFA metabolites and/or peroxidative degradation of LCPUFAs may contribute to the reduction of LCPUFA status in malnourished children. Restoration of normal energy,
protein, and EFA intakes does not appear to readily correct abnormalities of plasma and erythrocyte membrane LCPUFA values. Enhanced dietary supply of LCPUFAs and/or improved supply of
antioxidant vitamins may represent novel therapeutic modalities in severe PEM. With and without PEM,
HIV infection was related to altered availability of various EFAs and LCPUFAs in HIV-seropositive children. The plasma total
lipid fatty-acid profiles seen in well-nourished children with
HIV infection were compatible with an
HIV infection-related enhancement of the metabolic activity of the conversion of EFAs to their respective LCPUFA metabolites. However, the plasma
phospholipid EFA and LCPUFA profiles seen in severely malnourished children with
HIV infection more closely resembled those seen in children with PEM but without
HIV infection than in those in children with
HIV infection but no PEM. Metabolic studies using stable
isotope-labeled
fatty acids may contribute to better understanding of the HIV-related changes in EFA metabolism and clearly are needed before therapeutic conclusions can be drawn.