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Fatty Acids, Free


Definition


  • Free fatty acids are formed by the breakdown of lipoprotein and triglycerides. All but 2 " �5% of the serum fatty acids are esterified. The "nonesterified " � or "free " � fatty acids are protein bound. Epinephrine, norepinephrine, glucagon, TSH, and ACTH release free fatty acids. Tumors producing such hormones cause release of excessive quantities of free fatty acids. Other names: nonesterified fatty acids (NEFA), FFA.
  • Normal range:
    • Adults: 8 " �25 mg/dL or 0.28 " �0.89 mmol/L
    • Children (or obese adults): <31 mg/dL or <1.0 mmol/L

Use


  • Monitoring nutritional status in the presence of malabsorption, starvation, and long-term parenteral nutrition.
  • Valuable for the differential diagnosis of polyneuropathy when Refsum disease is suspected. In this disease, the enzyme that degrades phytanic acid is lacking.
  • Detection of pheochromocytoma and glucagon thyrotropin and adrenocorticotropin-secreting tumors.
  • Diabetes management.

Interpretation


Increased In


  • Poorly controlled DM
  • Pheochromocytoma
  • Hyperthyroidism
  • Huntington chorea
  • von Gierke disease
  • Alcoholism
  • Acute myocardial infarction
  • Reye syndrome
  • Phytanic acid increased in:
    • Refsum disease
    • Zellweger syndrome
    • Neonatal adrenoleukodystrophy
    • � �-Lipoproteinemia

Decreased In


  • CF
  • Malabsorption (acrodermatitis enteropathica)
  • Zinc deficiency (arachidonic acid and linoleic acid low)

Limitations


  • Free fatty acids increase by 12 " �25% in 24 hours in refrigerated plasma.
  • Strenuous exercise, anxiety, hypothermia, and long-term fasting elevate the levels.
  • Long-term IV or parenteral nutrition therapy decrease the levels.
  • Prolonged fasting or starvation affects levels (rise as much as three times normal).
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