We thank Esteve-Comas and Gassull for their interest in our study. As we emphasized in the article (1), it is difficult to correlate essential fatty acid status with clinical symptoms. Therefore, we have been cautious in promoting clinical recommendations based on our findings. Our physiologic study assessed the relation between parenteral and enteral supplementation of essential fatty acids and the status of these fatty acids in plasma phospholipids. We showed that larger amounts of parenteral linoleic acid are necessary to normalize linoleic acid concentrations in plasma phospholipids in patients with fat malabsorption compared with the amount provided enterally (1). However, we did not recommend that attempts should be made to normalize fatty acid status. We actually stated that "... the clinical benefits and cost-effectiveness of lipid supplementation should be considered before attempting to normalize the fatty acid status of HPN patients" (1).
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