{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T10:24:24Z","timestamp":1787826264153,"version":"build-2784847793"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To assess severity and risk of an essential fatty acid deficiency in children &lt;2 years with parenteral nutrition\u2013associated cholestasis on long\u2010term 100% fish\u2010oil lipid injectable emulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This longitudinal descriptive cohort study included patients receiving fish\u2010oil lipid injectable emulsion (1\u2009g\/kg\/day). Triene: tetraene ratios were monitored for up to 4 years and classified as mildly elevated (\u22650.05 and &lt;0.2) or essential fatty acid deficiency (\u22650.2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and twenty\u2010seven patients with a baseline median age of 14 weeks were included. Serum docosahexaenoic acid and eicosapentaenoic acid levels markedly increased, whereas arachidonic acid, linoleic acid, and \u03b1\u2010linolenic acid levels decreased before stabilizing. Median triene: tetraene ratios peaked at 0.027 at week 8 and then stabilized within a range of 0.015 and 0.020 from week 16 until the end of the study. Seven patients had mildly elevated triene: tetraene ratio at the end of the study. Three infants had an essential fatty acid deficiency, but none demonstrated clinical signs consistent with this deficiency. One deficiency was attributed to a laboratory error; two were associated with adverse events. All patients resolved with the continuation of fish\u2010oil lipid injectable emulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Children with parenteral nutrition\u2013associated cholestasis on long\u2010term fish\u2010oil lipid injectable emulsion are at low risk for a clinical or biochemical essential fatty acid deficiency. These findings indicate that despite its low content of linoleic acid and \u03b1\u2010linolenic acid, long\u2010term 1\u2009g\/kg\/day of 100% fish\u2010oil lipid injectable emulsion is not associated with an essential fatty acid deficiency.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpen.2785","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T02:44:43Z","timestamp":1750387483000},"page":"732-740","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Essential fatty acid deficiency in children treated with long\u2010term 100% fish\u2010oil lipid injectable emulsion: A longitudinal descriptive cohort study"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0431-896X","authenticated-orcid":false,"given":"Kathleen M.","family":"Gura","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Division of Gastroenterology, Hepatology, and Nutrition 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