Relationships between plasma and erythrocyte fatty acids in the de novo lipogenesis pathway, and metabolic disorders in French elderly patients

Abstract

Undernutrition has been identified as a major contributing factor to morbidity and mortality in hospitalized aged patients. The lipid calorie undernutrition may lead to de novo lipogenesis (DNL); among the endogenous fatty acids, 16: 1(n‐9) and 18:1 (n‐7) have been previously associated with a higher risk of sudden cardiac arrest (SCA). The aim was to examine possible associations between the fatty acids in the DNL pathway present in both plasma and erythrocytes of 188 patients aged 84 ± 7 years (48 men and 140 women) entering the geriatric department for evaluation and rehabilitation, and their metabolic disorders. The 18:1(n‐7) content in plasma cholesteryl esters (CE) was significantly higher in men (1.67 vs. 1.58% in women; P < 0.05). An inverse relationship was found between 18:1 (n‐7) and the two precursors of essential fatty acids (EFA), that is linoleic acid [18:2 (n‐6); LA] and alpha‐linolenic acid [18:3 (n‐3); ALA]. Moreover, an inverse relationship was found between 16: 1(n‐9) and LA. Sixty‐four percent of men suffered from dysglycemia versus 46% of women (P < 0.05). These patients were characterized by significantly higher content (+37%) of 16:1(n‐7) which derives mostly from DNL. Prevalence of metabolic syndrome (MetS) was 30–40%, associated with a higher level of 18:0, regardless of sex. Practical applications: Improving nutrition for the elderly patients is a key challenge for rehabilitation. The diet of our oldest old patients was low in total calories and low in fat; it might be partly responsible for the levels of fatty acids from DNL observed. Further study is needed to investigate whether it is possible to reduce both 18:1 (n‐7) and 16: 1(n‐9) levels. We propose to test the improvement of diet for our oldest old patients by increasing fat up to 70 g/d which is the lower limit of the recommended amounts. Simplified summary of the main objective: to examine potential relationships between the fatty acids in the DNL pathway and metabolic disorders (dysglycemia and MetS), factors of the cardiovascular risk in the elderly patients by sex.

Hospital Diet Enriched With Rapeseed or Sunflower Oils Is Associated With a Decrease in Plasma 16:1n‐7 and Some Metabolic Disorders in the Elderly

“…We also showed similar effects of the two oil‐enriched diets for decreasing the overall prevalence of dysglycemia and MetS. This is in accordance with our previous findings on the positive association between an increased proportion of 16:1n‐7 and dysglycemia (Henry et al, ) and with other studies that have reported positive associations between an increase in endogenous fatty acids and either the worsening of hyperglycemia (Mozaffarian et al, ), the insulin resistance (Mahendran et al, ), or MetS (Zong et al, ). Taken together, our results suggested that improving dysglycemia may be feasible in elderly men while at the same time decreasing the proportion of circulating endogenous fatty acids.…”

“…The hospital diet provided these patients with a lower-thanrecommended fat intake for the French elderly population (49.2 g/day compared to 70-80 g/day for women and 85-98 g/day for men) (Legrand, Morise, & Kalonji, 2011). Moreover, we showed a positive relationship between dysglycemia and plasma 16:1n-7 in these hospitalized elderly patients (Henry et al, 2016). A previous study (8) of postmenopausal women (63 AE 7 years) showed that the content of 16:1n-7 in plasma CE increased by 34.4% when energy from fat in the diet decreased from 29 to 17%, whereas 16:1n-7 decreased by 21.9% when energy from fat increased from 29 to 34%.…”

“…Patients included in the dietary intervention study (n = 111) were members of our previous group of patients (n = 188) who entered the geriatric department of Emile Roux Hospitals, Ile de France, for evaluation (baseline analysis of their health status) and rehabilitation (Henry et al, 2016), and they were recruited according to the following inclusion criteria: age ≥ 65 years; past history of CV disease involving coronary heart disease, cerebrovascular disease, hypertension; and Mini Mental Status Examination ≥ 15 of 30. Written informed consent was obtained from all participants after relevant information was provided to them and/or to their relatives.…”

“…Moreover, an earlier study had shown that increased human plasma content of 18:1n-7 was associated with a higher risk of sudden cardiac arrest (SCA) (JH et al, 2011). We previously found (Henry et al, 2016) a high prevalence of dysglycemia in hospitalized elderly patients, mainly in men (71% vs. 47% in women), and half of dysglycemic patients suffered from chronic inflammation. The hospital diet provided these patients with a lower-thanrecommended fat intake for the French elderly population (49.2 g/day compared to 70-80 g/day for women and 85-98 g/day for men) (Legrand, Morise, & Kalonji, 2011).…”

“…SO was chosen because it is the most commonly used oil in hospitals in France, and RO was chosen as a comparative oil due to its interesting fatty acid profile (9% ALA). Because we have already found that the prevalence of dysglycemia is higher in elderly men than in elderly women (Henry et al, 2016), and that favorable changes in glucose/insulin homeostasis have been observed only in men in response to the Mediterranean diet (Bédard, Corneau, Lamarche, & Lemieux, 2014), we compared for each gender the effects of the two diets supplemented with SO or RO on the relative levels (mol%) of circulating endogenous fatty acids and the prevalence of metabolic disorders related to CV risk. Fatty acid data were obtained through the analysis of compositions of both biomarkers, (1) plasma CE for assessing EFA intake and fatty acids in the DNL pathway and (2) erythrocyte phospholipids (PL) for assessing (n-6) and (n-3) long-chain polyunsaturated fatty acid (LC-PUFA) status.…”