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Lee YY, Tang TK, Chan ES, Phuah ET, Lai OM, Tan CP, Wang Y, Ab Karim NA, Mat Dian NH, Tan JS. Medium chain triglyceride and medium-and long chain triglyceride: metabolism, production, health impacts and its applications - a review. Crit Rev Food Sci Nutr 2021; 62:4169-4185. [PMID: 33480262 DOI: 10.1080/10408398.2021.1873729] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Structured lipid is a type of modified form of lipid that is "fabricated" with the purpose to improve the nutritional and functional properties of conventional fats and oils derived from animal and plant sources. Such healthier choice of lipid received escalating attention from the public for its capability to manage the rising prevalence of metabolic syndrome. Of which, medium-chain triacylglycerol (MCT) and medium-and long-chain triacylglycerol (MLCT) are the few examples of the "new generation" custom-made healthful lipids which are mainly composed of medium chain fatty acid (MCFA). MCT is made up exclusively of MCFA whereas MLCT contains a mixture of MCFA and long chain fatty acid (LCFA), respectively. Attributed by the unique metabolism of MCFA which is rapidly metabolized by the body, MCFA and MCT showed to acquire multiple physiological and functional properties in managing and reversing certain health disorders. Several chemically or enzymatically oils and fats modification processes catalyzed by a biological or chemical catalyst such as acidolysis, interesterification and esterification are adopted to synthesis MCT and MLCT. With their purported health benefits, MCT and MLCT are widely being used as nutraceutical in food and pharmaceutical sectors. This article aims to provide a comprehensive review on MCT and MLCT, with an emphasis on the basic understanding of its structures, properties, unique metabolism; the current status of the touted health benefits; latest routes of production; its up-to-date applications in the different food systems; relevant patents filed and its drawbacks.
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Affiliation(s)
- Yee-Ying Lee
- School of Science, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.,Monash Industry Palm Oil Research and Education Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Teck-Kim Tang
- International Joint Laboratory on Plant Oils Processing and Safety, Jinan University- Universiti Putra Malaysia.Institute of Bioscience, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Eng-Seng Chan
- Monash Industry Palm Oil Research and Education Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.,School of Engineering, Department of Chemical Engineering, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Eng-Tong Phuah
- Department of Agricultural and Food Science, Universiti Tunku Abdul Rahman, Kampar, Perak, Malaysia
| | - Oi-Ming Lai
- International Joint Laboratory on Plant Oils Processing and Safety, Jinan University- Universiti Putra Malaysia.Institute of Bioscience, University Putra Malaysia, Serdang, Selangor, Malaysia.,Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, University Putra Malaysia, Serdang, Selangor
| | - Chin-Ping Tan
- International Joint Laboratory on Plant Oils Processing and Safety, Jinan University- Universiti Putra Malaysia. Department of Food Technology, Faculty of Food Science and Technology, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Yong Wang
- International Joint Laboratory on Plant Oils Processing and Safety, Jinan University- Universiti Putra Malaysia. Department of Food Science and Engineering, Jinan University, Guangzhou, P.R. China
| | - Nur Azwani Ab Karim
- Sime Darby Research Sdn Bhd, R&D Carey Island-Upstream, Carey Island, Selangor, Malaysia
| | - Noorlida Habi Mat Dian
- Malaysia Palm Oil Board, 6 Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Joo Shun Tan
- Bioprocess Technology, School of Industrial Technology, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
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Chambrier C, Lauverjat M, Bouletreau P. Structured Triglyceride Emulsions in Parenteral Nutrition. Nutr Clin Pract 2017; 21:342-50. [PMID: 16870802 DOI: 10.1177/0115426506021004342] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Over the past 3 decades, various concepts for IV fat emulsions (IVFE) have been developed. A randomized, structured-lipid emulsion based on an old technology has recently become available. This structured-lipid emulsion is produced by mixing medium-chain triglycerides and long-chain triglycerides, then allowing hydrolysis to form free fatty acids, followed by random transesterification of the fatty acids into mixed triglyceride molecules. Studies in animals have shown an improvement in nitrogen balance with the use of these lipid emulsions. Only 8 human clinical studies with these products have been performed. The results of these human clinical studies have been less promising than the animal studies; however, an improvement in nitrogen balance and lipid metabolism exceeds results associated with infusion of long-chain triglycerides (LCT) or a physical mixture of long-chain triglycerides and medium-chain triglycerides (LCT-MCT). Structured-lipid emulsion seems to induce less elevation in serum liver function values compared with standard IVFEs. In addition, structured-lipid emulsions have no detrimental effect on the reticuloendothelial system. Further studies are necessary in order to recommend the use of structured-lipid emulsions. The clinical community hopes that chemically defined structured triglycerides will make it possible to determine the distribution of specific fatty acids on a specific position on the glycerol core and therefore obtain specific activity for a specific clinical situation.
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Affiliation(s)
- C Chambrier
- Unité de Nutrition Clinique Intensive, Hôpital Edouard Herriot, 5 place d'Arsonval, 69003 Lyon, France.
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Demirer S, Sapmaz A, Karaca AS, Kepenekci I, Aydintug S, Balci D, Sonyurek P, Kose K. Effects of postoperative parenteral nutrition with different lipid emulsions in patients undergoing major abdominal surgery. Ann Surg Treat Res 2016; 91:309-315. [PMID: 27904853 PMCID: PMC5128377 DOI: 10.4174/astr.2016.91.6.309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 06/21/2016] [Accepted: 08/03/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was designed to investigate the effects of total parenteral nutrition (PN) using different lipid emulsions in patients undergoing major abdominal surgery. METHODS Fifty-two patients were randomized to receive soybean oil + medium chain triglycerides (MCT) (group I), soybean oil + olive oil (group II), soybean oil + olive oil + fish oil (group III) as a lipid source. PN was started on postoperative day 1 and patients were maintained on PN for a minimum period of 4 days. Laboratory variables (CRP, prealbumin, transferrin) were measured before surgery and on postoperative days. RESULTS Three treatment groups were included in the study. Patients in group I received long chain triglycerides (LCT) + LCT/MCT emulsion (%75 LCT + %25 LCT/MCT); Patients in group II received olive oil based emulsion (80% olive oil + 20% soybean oil, ClinOleic); Patients in group III received fish oil in addition to olive oil based emulsion (%85 ClinOleic + %15 Omegaven; Fresenius Kabi). The following 14 parameters were assessed: body weight, CRP, prealbumin, transferrin, tumor necrosis factor-α, interleukin-6, total antioxidant status, thiobarbituric acid reactive substances, oxidized low density lipoprotein-2, complete blood cell, international normalized ratio, D-dimer, activated partially thromboplastin time, prothrombin time. All other parameters showed no differences among the groups. CONCLUSION The results of our trial demonstrate a potential beneficial effect of soybean oil/olive oil based lipid emulsions for use in PN regarding inflammatory response and oxidant capacity in the treatment of patients.
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Affiliation(s)
- Seher Demirer
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Sapmaz
- Ankara Numune Education and Research Hospital, Ankara, Turkey
| | | | - Ilknur Kepenekci
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Semih Aydintug
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Deniz Balci
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Pinar Sonyurek
- Ankara University School of Medicine Nutrition Team, Ankara, Turkey
| | - Kenan Kose
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
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Hartman C, Ben-Artzi E, Berkowitz D, Elhasid R, Lajterer N, Postovski S, Hadad S, Shamir R. Olive oil-based intravenous lipid emulsion in pediatric patients undergoing bone marrow transplantation: A short-term prospective controlled trial. Clin Nutr 2009; 28:631-5. [DOI: 10.1016/j.clnu.2009.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 01/31/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
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Alexandrou E, Herzberg GR, White MD. High-level medium-chain triglyceride feeding and energy expenditure in normal-weight women. Can J Physiol Pharmacol 2007; 85:507-13. [PMID: 17632585 DOI: 10.1139/y07-034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to assess how short-term feeding of high levels of dietary medium-chain triglyceride (MCT) affect energy expenditure and postprandial substrate oxidation rates in normal-weight, premenopausal women. Eight healthy women were fed both a MCT-rich and an isocaloric long-chain triglyceride (LCT)-rich diet for two 1-week periods separated by a minimum of 21 days. The energy intake in each diet was 45% carbohydrates, 40% fat, and 15% protein. The 2 diets had either 60.81% or 1.11% of total fat energy from MCT with the remaining fat energy intake from LCT. On days 1 and 7 of each diet, resting metabolic rate and postprandial energy expenditure (EE) were measured by indirect calorimetry with a ventilated hood. Results indicated on days 1 and 7, there were no significant differences between diets for resting metabolic rate or mean postprandial EE. On both days 1 and 7, fat oxidation for the MCT-rich diet was significantly greater (0.0001 </= p </= 0.04) than that for the LCT-rich diet at different time points across the 5.5 h postprandial period. In conclusion, for premenopausal, normal-weight women consuming a diet with 25% of the energy content from MCT, there were no changes in resting metabolic rate, transient increases in postprandial energy expenditure, and significant increases in postprandial fat oxidation.
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Affiliation(s)
- Elena Alexandrou
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL A1C 5S7, Canada
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Pfeffer J, Freund A, Bel-Rhlid R, Hansen CE, Reuss M, Schmid RD, Maurer SC. Highly efficient enzymatic synthesis of 2-monoacylglycerides and structured lipids and their production on a technical scale. Lipids 2007; 42:947-53. [PMID: 17623117 DOI: 10.1007/s11745-007-3084-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 05/14/2007] [Accepted: 05/27/2007] [Indexed: 11/25/2022]
Abstract
We report here a two-step process for the high-yield enzymatic synthesis of 2-monoacylglycerides (2-MAG) of saturated as well as unsaturated fatty acids with different chain lengths. The process consists of two steps: first the unselective esterification of fatty acids and glycerol leading to a triacylglyceride followed by an sn1,3-selective alcoholysis reaction yielding 2-monoacylglycerides. Remarkably, both steps can be catalyzed by lipase B from Candida antarctica (CalB). The whole process including esterification and alcoholysis was scaled up in a miniplant to a total volume of 10 l. With this volume, a two-step process catalyzed by CalB for the synthesis of 1,3-oleoyl-2-palmitoylglycerol (OPO) using tripalmitate as starting material was established. On a laboratory scale, we obtained gram quantities of the synthesized 2-monoacylglycerides of polyunsaturated fatty acids such as arachidonic-, docosahexaenoic- and eicosapentaenoic acids and up to 96.4% of the theoretically possible yield with 95% purity. On a technical scale (>100 g of product, >5 l of reaction volume), 97% yield was reached in the esterification and 73% in the alcoholysis and a new promising process for the enzymatic synthesis of OPO was established.
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Affiliation(s)
- Jan Pfeffer
- Institute of Technical Biochemistry, University of Stuttgart, Allmandring 31, 70569 Stuttgart, Germany
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ZHOU DEQUAN, XU XUEBING, MU HUILING, HØY CARLERIK, ADLER-NISSEN JENS. LIPASE-CATALYZED PRODUCTION OF STRUCTURED LIPIDS VIA ACIDOLYSIS OF FISH OIL WITH CAPRYLIC ACID. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1745-4522.2000.tb00177.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chambrier C, Lauverjat M, Boulétreau P. Émulsions lipidiques : indication des différentes émulsions lipidiques. NUTR CLIN METAB 2006. [DOI: 10.1016/j.nupar.2006.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zhou D, Xu X, Mu H, Høy CE, Adler-Nissen J. Synthesis of structured triacylglycerols containing caproic acid by lipase-catalyzed acidolysis: optimization by response surface methodology. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2001; 49:5771-5777. [PMID: 11743762 DOI: 10.1021/jf0103020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Production in a batch reactor with a solvent-free system of structured triacylglycerols containing short-chain fatty acids by Lipozyme RM IM-catalyzed acidolysis between rapeseed oil and caproic acid was optimized using response surface methodology (RSM). Reaction time (t(r)), substrate ratio (S(r)), enzyme load (E(l), based on substrate), water content (W(c), based on enzyme), and reaction temperature (T(e)), the five most important parameters for the reaction, were chosen for the optimization. The range of each parameter was selected as follows: t(r) = 5-17 h; E(l) = 6-14 wt %; T(e) = 45-65 degrees C; S(r) = 2-6 mol/mol; and W(c) = 2-12 wt %. The biocatalyst was Lipozyme RM IM, in which Rhizomucor miehei lipase is immobilized on a resin. The incorporation of caproic acid into rapeseed oil was the main monitoring response. In addition, the contents of mono-incorporated structured triacylglycerols and di-incorporated structured triacylglycerols were also evaluated. The optimal reaction conditions for the incorporation of caproic acid and the content of di-incorporated structured triacylglycerols were as follows: t(r) = 17 h; S(r) = 5; E(l) = 14 wt %; W(c) = 10 wt %; T(e) = 65 degrees C. At these conditions, products with 55 mol % incorporation of caproic acid and 55 mol % di-incorporated structured triacylglycerols were obtained.
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Affiliation(s)
- D Zhou
- BioCentrum-DTU, Center for Advanced Food Studies, Technical University of Denmark, DK-2800 Lyngby, Denmark
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Mu H, Høy CE. Effects of different medium-chain fatty acids on intestinal absorption of structured triacylglycerols. Lipids 2000; 35:83-9. [PMID: 10695928 DOI: 10.1007/s11745-000-0498-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To study the effect of the chain length of medium-chain fatty acids on the intestinal absorption of long-chain fatty acids, we examined the lymphatic transport of fat following administration of five purified structured triacylglycerols (STAG) containing different medium-chain fatty acids in the sn-1,3 positions and long-chain fatty acids in the sn-2 position in a rat model. Significant amounts of medium-chain fatty acids were found in lymph samples after intragastric administration of 1,3-dioctanoyl-2-linoleyl-sn-glycerol (8:0/18:2/8:0), 1,3-didecanoyl-2-linoleyl-sn-glycerol, and 1,3-didodecanoyl-2-linoleyl-sn-glycerol. The accumulated lymphatic transport of medium-chain fatty acids increased with increasing carbon chain length. The recoveries of caprylic acid (8:0), capric acid (10:0), and lauric acid (12:0) were 7.3 +/- 0.9, 26.3 +/- 2.4, and 81.7 +/- 6.9%, respectively. No significant differences were observed for the maximal intestinal absorption of linoleic acid (18:2n-6) when the chain length of medium-chain fatty acids at the primary positions was varied, and the absorption of 18:2 and oleic acid (18:1) from 8:0/18:2/8:0 and 1,3-dioctanoyl-2-oleyl-sn-glycerol was similar. We conclude that the chain length of the medium-chain fatty acids in the primary positions of STAG does not affect the maximal intestinal absorption of long-chain fatty acids in the sn-2 position in the applied rat model, whereas the distribution of fatty acids between the lymphatics and the portal vein reflects the chain length of the fatty acids.
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Affiliation(s)
- H Mu
- Department of Biochemistry & Nutrition, Center for Advanced Food Study, Technical University of Denmark, Lyngby.
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12
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Akoh CC, Moussata CO. Lipase-catalyzed modification of borage oil: Incorporation of capric and eicosapentaenoic acids to form structured lipids. J AM OIL CHEM SOC 1998. [DOI: 10.1007/s11746-998-0208-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Casimir C. Akoh
- ; Department of Food Science and Technology; The University of Georgia; Food Science Building, Room 211 Athens GA 30602-7610
| | - Charment O. Moussata
- ; Department of Food Science and Technology; The University of Georgia; Food Science Building, Room 211 Athens GA 30602-7610
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13
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Affiliation(s)
- P Fürst
- University of Hohenheim, Institute for Biological Chemistry and Nutrition, D-70593 Stuttgart, Germany
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Czernichow B, Galluser M, Cui S, Gossé F, Raul F. Comparison of enteral or parenteral administration of medium chain triglycerides on intestinal mucosa in adult rats. Nutr Res 1996. [DOI: 10.1016/0271-5317(96)00072-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hyltander A, Sandström R, Lundholm K. Metabolic effects of structured triglycerides in humans. Nutr Clin Pract 1995; 10:91-7. [PMID: 7616934 DOI: 10.1177/011542659501000391] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This review considers the development of structured triglycerides as an IV nutrient source. The replacement of a portion of long-chain fatty acids in the conventional fat emulsion triglycerides confers favorable qualities on these lipids and renders them attractive as an energy source, particularly in critically ill patients. This report considers the features of structured triglycerides that may make them competitive or even more efficient as an energy source compared with conventional fat emulsions.
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Les lipides structurés à base d'acides gras à chaîne moyenne. Actualité et perspectives en nutrition artificielle. NUTR CLIN METAB 1993. [DOI: 10.1016/s0985-0562(05)80054-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The manipulation of dietary fat intake can affect the response to disease, injury, and infection. These effects include enhancement or inhibition of immune function, altered susceptibility to cardiovascular disease, promotion or maintenance of gut integrity, and prevention of total parenteral nutrition-induced hepatic dysfunction. These effects may occur as a result of changes in the fatty acid composition of biomembranes or changes in concentrations of lipid moieties such as prostaglandins or leukotrienes. Those fats that have been shown to affect physiologic function include long-chain, medium-chain, and short-chain fatty acids and omega-3 and omega-6 fatty acids. Currently available enteral and parenteral products used for nutrition support contain widely varied amounts of these different fatty acids. Therefore, the selection of the most appropriate product or nutrition support regimen for an individual patient requires an understanding of the metabolism of these different fat substrates, their therapeutic indications, and the contraindications and controversies that surround their use. This article reviews these issues and also focuses on several alternate lipid sources such as short-chain fatty acids, medium-chain fatty acids, omega-3 fatty acids, and blended and structured lipids.
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Garfinkel M, Lee S, Opara EC, Akwari OE. Insulinotropic potency of lauric acid: a metabolic rationale for medium chain fatty acids (MCF) in TPN formulation. J Surg Res 1992; 52:328-33. [PMID: 1593871 DOI: 10.1016/0022-4804(92)90111-c] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The need for a better lipid system to satisfy the fuel requirements of patients while avoiding the adverse effects of current systems has led to suggestions that medium chain fatty acids (MCFs) be incorporated into TPN-lipid emulsions. Since clinical situations requiring TPN are associated with metabolic processes mediated by insulin, in the present study we have therefore examined the effects of a variety of medium chain fatty acids on insulin release. Using an isolated perifused mouse islet model, various doses of medium chain fatty acids and the essential fatty acid, linoleic acid, were tested and compared. The possibility of an additive effect of an insulinotropic MCF and linoleate when both are provided together was also examined. Effluent perifusate samples collected on ice during these experiments were assayed for insulin by radioimmunoassay. It was found that the ability of 5 mM of a given MCF to stimulate insulin secretion was dependent upon its chain length. Thus, while adipic acid (C6) had no effect, Caprylic acid (C8) had a minimal effect that was not statistically significant, but capric acid (C10) and lauric acid had very potent effects that were of the same magnitude to the effect of linoleate on insulin secretion. When insulin output was assessed as the mean integrated area under the curve during a 20-min perifusion, 5 mM lauric acid enhanced insulin secretion from a basal 7351 +/- 666 pg to 15,756 +/- 1680 pg (P less than 0.01, n = 5). In the same experiments, 5 mM linoleic acid stimulated insulin release to 11,260 +/- 867 pg (P less than 0.05). When C12 and linoleate were added together, each at a submaximally effective concentration of 2.5 mM, insulin output was 12,712 +/- 1011 pg (P less than 0.05, n = 5), which was not statistically different from the values obtained when the islets were perifused with 5 mM of each fatty acid alone.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Garfinkel
- Department of Surgery, Duke University Medical School, Durham, North Carolina 27710
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Abstract
The report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults published in 1988 evoked great interest from the medical profession, the public, and food manufacturers. The merits of different dietary interventions to lower plasma cholesterol are debated in advertising, popular publications, and research publications. The present paper is a review of the contributions of saturated and trans fatty acids (FA) to the US diet, their metabolism, and effects upon plasma cholesterol. Saturated (SFA) and trans FA are metabolized to yield energy. They are not dietary essentials; SFA can be biosynthesized, and trans FA are not naturally occurring in plants, with only very small amounts in animals. Trans FA are produced in hydrogenation of liquid vegetable oils and are estimated to contribute 3-7% of the fat consumed. Most of the SFA in the US diet (35% of total fat consumed) is obtained from meat, poultry, fish, and dairy products (approximately 60%). The fats and oils consumed directly or as components of food products, mostly baked goods, contribute approximately 20% of the SFA. More than 30 years of research led the NCEP to conclude that SFA was the most potent dietary component in increasing plasma cholesterol, and that no more than 10% of the energy (en%) of the diet should be SFA. Trans FA are metabolized similarly to SFA, but no recommendation has been made about their consumption. Reduction of consumption of SFA should be practiced in a prudent manner, by reducing consumption of foods high in SFA, and not by eliminating classes of foods. Some changes in formulations of foods or preparation practices (type of frying fat) can be made. These modifications may decrease the palatability of the food, thereby presenting a challenge to the food industry. Substitution of fats hydrogenated to contain trans FA for fats high in SFA may not be beneficial to health. Labeling of foods would improve the ability of the consumer to make appropriate choices.
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Affiliation(s)
- J Dupont
- Department of Food and Nutrition, Iowa State University, Ames
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Haw MP, Bell SJ, Blackburn GL. Potential of parenteral and enteral nutrition in inflammation and immune dysfunction: A new challenge for dietitians. ACTA ACUST UNITED AC 1991. [DOI: 10.1016/s0002-8223(21)01208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Swenson ES, Selleck KM, Babayan VK, Blackburn GL, Bistrian BR. Persistence of metabolic effects after long-term oral feeding of a structured triglyceride derived from medium-chain triglyceride and fish oil in burned and normal rats. Metabolism 1991; 40:484-90. [PMID: 2023535 DOI: 10.1016/0026-0495(91)90229-p] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The persistence of metabolic effects following long-term oral feeding of a structured triglyceride rich in omega-3 fatty acids was studied in burned and normal rats, and compared with controls fed safflower oil, a long-chain triglyceride high in omega-6 fatty acid content. Male Sprague-Dawley rats were pair-fed a high fat diet as either structured triglyceride or safflower oil for 42 days. On day 43, a jugular catheter was placed, and rats received either a dorsal surface scald or sham injury. Following a 48-hour fast, body weight, nitrogen loss, energy metabolism, and liver weight were measured, and whole-body and tissue-specific protein kinetics were studied by constant intravenous infusion of [1-14C]leucine. Plasma albumin, free fatty acids, glucose, insulin, and triglyceride fatty acid composition were determined. Urinary nitrogen loss, energy expenditure, and plasma leucine concentration were elevated in burned rats, confirming the presence of an injury response. Rats previously fed structured triglyceride had greater liver weight, total liver protein, and percentage of leucine flux oxidized, and plasma levels of glucose and insulin were increased. Plasma leucine concentration was decreased in rats previously fed structured triglyceride. Plasma triglyceride and phospholipid fatty acid analysis showed a reduction in arachidonic acid and an increase in omega-3 fatty acids in rats previously fed structured triglyceride. Long-term feeding of structured triglyceride induced major systemic metabolic changes related to the dietary fatty acid composition that persist after the diet is discontinued.
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Affiliation(s)
- E S Swenson
- Laboratory of Nutrition/Infection, New England Deaconess Hospital, Boston, MA 02215
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Alternative lipid sources for enteral and parenteral nutrition: Long- and medium-chain triglycerides, structured triglycerides, and fish oils. ACTA ACUST UNITED AC 1991. [DOI: 10.1016/s0002-8223(21)01066-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
UNLABELLED Triacetin, the water-soluble triglyceride of acetate, was infused in mongrel dogs at isocaloric (N = 6) or hypercaloric (approximately 1.5 REE, N = 7) rates in mongrel dogs for 3 hr. Ketone body and glucose production rates were quantified with [13C2] acetoacetate and [3H]glucose, respectively. Four additional animals were infused with glycerol to serve as controls for the hypercaloric triacetin infusion. Energy expenditure was determined in the isocaloric experiments. RESULTS no evidence of acute toxicity was observed during triacetin infusion at either rate. Plasma acetate concentrations increased from basal levels to approximately 1 and approximately 13 mmol/liter in the isocaloric and hypercaloric experiments, respectively. Plasma lactate and pyruvate concentrations decreased dramatically after 30 min of both isocaloric and hypercaloric triacetin infusions. Glucose production rates did not increase in either group, but glucose clearance decreased significantly in both groups (p less than 0.05) over the last hour of triacetin infusion. Plasma ketone body concentrations increased from 1.4 to 3.5 and 1.8 to 13.5 mumol/kg.min, respectively, during isocaloric and hypercaloric triacetin infusion. Resting energy expenditure increased from 3.0 +/- 0.3 to 4.0 +/- 0.5 kcal/kg.hr during isocaloric triacetin infusion (p less than 0.05). These studies indicate that triacetin can be administered to dogs at high rates without overt toxicity. The decrease in glucose clearance may represent competition between carbohydrate (glucose) and lipid (acetate). Triacetin infusion resulted in significant increases in ketone body production and concentration. These preliminary data indicate that triacetin may have a future role as a parenteral nutrient, and that further studies of its use are warranted.
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Affiliation(s)
- J W Bailey
- Department of Medicine, Mayo Medical School, Rochester, Minnesota 55905
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25
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Rosenthal E, Weissman B, Kyllonen K. Use of parenteral medium-chain triglyceride emulsion for maintaining seizure control in a 5-year-old girl with intractable diarrhea. JPEN J Parenter Enteral Nutr 1990; 14:543-5. [PMID: 2122029 DOI: 10.1177/0148607190014005543] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Medium-chain triglycerides (MCT) are an important component of an enteral ketogenic diet for seizure control. Previously, it was difficult to maintain ketosis when parenteral (iv) nutrition therapy was necessary. The use of iv MCT in a 5-year-old girl with Lennox-Gastaut syndrome who had diarrhea and dehydration is reported. Conventional 20% iv fat emulsion (long-chain triglycerides, LCT) and dextrose free hyperalimentation (HAL) in a 4:1 ketogenic ratio did not maintain adequate ketosis during bowel rest. Compassionate use of iv MCT (Clintec Nutrition) infused as a 70:30 MCT/LCT ratio plus HAL maintained moderate ketosis. Seizures were well controlled during the iv MCT regimen, which allowed normal daily functioning. Complications included abnormal liver function tests and severe iron deficiency anemia of unknown etiology. Serum triglyceride and cholesterol levels increased to 1717 mg/dl and 614 mg/dl, respectively, but decreased with a reduction of lipid infusion and use of an antihyperlipemic drug. Nutritional status was maintained. In this case, iv MCT proved to be a relatively safe and effective short-term method of continuing parenteral nutrition while maintaining ketosis for seizure control.
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Affiliation(s)
- E Rosenthal
- Department of Nutrition Services, Rainbow Babies and Children's Hospital, Cleveland, OH 44106
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26
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Jensen GL, Mascioli EA, Seidner DL, Istfan NW, Domnitch AM, Selleck K, Babayan VK, Blackburn GL, Bistrian BR. Parenteral infusion of long- and medium-chain triglycerides and reticuloendothelial system function in man. JPEN J Parenter Enteral Nutr 1990; 14:467-71. [PMID: 2122019 DOI: 10.1177/0148607190014005467] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Previous study demonstrated that patients who received total parenteral nutrition (TPN) with standard intermittent infusion of long chain triglyceride (LCT) at 0.13 g kg-1hr-1 over 10 hr for each of three days showed a significant decline in 99Tc-sulfur colloid (TSC) clearance rate by the reticuloendothelial system (RES). The present studies evaluated eight patients who received the same total lipid dose of LCT infused continuously as in a three-in-one admixture, and another nine patients receiving the same amount of fat as a medium chain triglyceride (MCT)/LCT (75%/25%) emulsion intermittently over 10 hr at 0.13 g kg-1hr-1 for three consecutive days. Patients were given continuous total parenteral nutrition (TPN) comprised of protein, 1.5 g kg-1day-1, and dextrose, 4.5 g kg-1day-1. RES function was examined by measuring the clearance rates of intravenously injected TSC while receiving TPN containing only protein and dextrose, and again after three days of fat infusion. Mean (+/- SEM) clearance rate constants before and after continuous LCT infusion were 0.38 +/- 0.09 and 0.41 +/- 0.08 min-1, respectively, while those before and after intermittent MCT/LCT infusion were 0.50 +/- 0.18 and 0.73 +/- 0.24 min-1, respectively. In contrast to intermittent LCT infusion, the administration of continuous LCT or an intermittent MCT/LCT mixture does not impair TSC clearance by the RES. These findings suggest that condensing the daily period of LCT infusion at standard dosage may exceed the rate of metabolic utilization, resulting in increased fat removal and diminished TSC uptake by the RES.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G L Jensen
- Nutrition/Metabolism Laboratory, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Bach AC, Frey A, Lutz O. Clinical and experimental effects of medium-chain-triglyceride-based fat Emulsions—A review. Clin Nutr 1989; 8:223-35. [PMID: 16837294 DOI: 10.1016/0261-5614(89)90032-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/1988] [Accepted: 01/23/1989] [Indexed: 11/17/2022]
Abstract
Although total parenteral nutrition usually includes lipids, traditional long-chain triglyceride (LCT) emulsions do not fulfil the energy-providing role allotted to them. The special properties of medium-chain triglycerides (MCTs) and fatty acids led to replacement of part of the infused LCTs by MCTs. The present review shows that: 1. MCT/LCT emulsions are as safe and as well tolerated as the traditional emulsions, and contain enough essential fatty acids to meet patients' needs. 2. Relative to LCT emulsions, MCT/LCT emulsions exhibit a number of differences: * More rapid clearance from the circulation. Lipoprotein lipase and hepatic lipase hydrolyse them preferentially. * Decreased liability to be deposited as fat, in adipose tissue and liver. They do not overload the reticula-endothelial system, which may better preserve its capacity to phagocytose bacteria. * More rapid and complete oxidation, Faster energy provision for all tissues, even though a small part is dissipated in a clinical non-relevant thermogenesis and by o-oxidation. They are ketogenic if infused alone. * Concomitant administration of glucose does not influence their clearance rate, only slightly decreases their oxidation rate, but prevents the acceleration of ketogenesis. Two other properties of MCT/LCT emulsions are probable, though not confirmed: * exchanges of lipids between artificial fat particles and plasma lipoproteins may be less with these emulsions than with LCTs, though it is not yet known what effect diminished disturbance of lipoprotein homeostasis has on the organism. * The nitrogen-sparing effect of a TPN regimen containing MCTs/LCTs seems better than a regimen providing LCTs only.
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Affiliation(s)
- A C Bach
- Laboratoire de la Clinique Médicale A, Hôpital Civil, 67091 Strasbourg Cedex, France
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28
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Abstract
The collective evidence suggests that nutritional insult to both cell-mediated and humoral immunity in the presence of protein-energy malnutrition contributes to abnormalities of inflammation. The primary goal of nutritional support in inflammatory disease is to provide adequate energy and protein to meet endogenous requirements for tissue repair, IL-1 production, and restored cellular function, thus preventing secondary infection. Substrate provision should aim at improving the acute phase of injury while avoiding immune dysfunction. This goal may be achieved by altering the eicosanoid pathway toward a more regulated inflammatory state. In the context of allograft response, macrophages are central to the initiation of allosensitization by virtue of their ability to present antigen to T-cells. Activated T-cells may further modulate macrophage function by the secretion of lymphokines. Manipulation of macrophage eicosanoid production by dietary omega-3 PUFA may reduce cellular immune response. (table; see text) Nutritional support should also focus on providing essential micronutrients, with their potentially immunomodulating role, as adjunctive therapy in order to protect the host from toxic effects of free-radicals and chemicals released during inflammatory events. (Feeding regimens currently under investigation and development are presented in Table 4.) By integrating dietary immunotherapy with the use of recombinant hormones, monoclonal antibodies, and various available monokines, an optimal outcome for each patient may be achieved. However, effective application of immunotherapy to nutritional supplementation will require accurate monitoring of immune function in individual patients in order to avoid inappropriate treatment.
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Affiliation(s)
- J M Wan
- Department of Surgery, Harvard Medical School, New England Deaconess Hospital, Boston, MA 02115
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29
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30
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Mascioli EA, Babayan VK, Bistrian BR, Blackburn GL. Novel triglycerides for special medical purposes. JPEN J Parenter Enteral Nutr 1988; 12:127S-132S. [PMID: 3063836 DOI: 10.1177/014860718801200620] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The clinical use of intravenous lipid emulsions have been routine for over 25 years. For most of that time period the use of the vegetable oils, soybean and safflower, were the exclusive lipid source for these emulsions. Recently intravenous medium-chain triglycerides have been commercially available. This review will discuss several important new research developments coming from the laboratory which should prove to enhance the nutritional effectiveness as well as minimize the adverse effects of lipid emulsions. The use of medium-chain triglycerides either enterally or parenterally has shown them to be superior energy sources when compared to long-chain triglycerides. Under experimental conditions of burn injury, their support of certain aspects of protein metabolism is superior to that of the current emulsions. This may be due to their rapid and preferential oxidation and poor storage into adipose tissue, and increased thermogenesis which has been observed from either enteral or parenteral administration in humans. This increased metabolic rate is not accompanied by an increase in temperature. Lipid emulsions have been described as having many different effects on variable aspects of the immunologic system. Some of these could be considered to be beneficial or without harm, and others are considered potentially deleterious. We have focused on the effects of parenteral lipid emulsions, in animals as well as in humans, on the function of the reticuloendothelial system.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E A Mascioli
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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31
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Bach AC, Storck D, Meraihi Z. Medium-chain triglyceride-based fat emulsions: an alternative energy supply in stress and sepsis. JPEN J Parenter Enteral Nutr 1988; 12:82S-88S. [PMID: 3063844 DOI: 10.1177/014860718801200610] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Medium-chain triglycerides (MCTs) and medium-chain fatty acids (MCFAs) have special physicochemical properties such as small molecular weight, small interfacial tension against water, and for the fatty acids, solubility in biological fluids. As a result the metabolic pathways followed by these fats in an organism are different and simpler, or identical but more rapid, than those followed by long-chain triglycerides (LCTs) and long-chain fatty acids (LCFAs). Consequently the MCTs have found numerous applications in oral or enteral nutrition and, more recently, in parenteral nutrition. The infusion of conventional fat emulsions in stress and sepsis is still controversial. A main question is whether an MCT supply can be beneficial for these patients. In this review, we will discuss different aspects of modified lipid and protein metabolism: exchanges between exogenous fat particles and lipoproteins; exogenous fat clearance, storage, and oxidation; reticuloendothelial system function; nitrogen balance; and hepatic function. For each of these perturbations, the MCT/LCT and structured lipid emulsions are theoretically capable to provide an appropriate solution. The efficiency of these emulsions has been demonstrated experimentally on animal models of stress and sepsis. However, the value of MCT-based fat emulsions for these pathological states has still to be ascertained by clinical studies.
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Affiliation(s)
- A C Bach
- Clinique Médicale A, Hôpital Civil, Strasbourg, France
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32
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DeMichele SJ, Karlstad MD, Babayan VK, Istfan N, Blackburn GL, Bistrian BR. Enhanced skeletal muscle and liver protein synthesis with structured lipid in enterally fed burned rats. Metabolism 1988; 37:787-95. [PMID: 3136299 DOI: 10.1016/0026-0495(88)90016-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We assessed the effects of total enteral nutrition with long-chain triacylglycerides (LCT), medium-chain triacylglycerides (MCT), or two structured lipids, modified dairy fat (MDF) and modified MCT (Captex 810B, Capital City Products, Columbus, OH), on protein and energy metabolism in hypermetabolic burned rats (25% to 30% body surface area). Male Sprague-Dawley rats (200 +/- 10 g) were continuously gastrostomy-fed isovolemic diets that provided 50 kcal/d, 2 g amino acids/d and 40% nonprotein calories as lipid for three days. Changes in body weight, nitrogen balance, serum albumin, indirect calorimetry, whole body leucine kinetics, and rectus muscle and liver protein kinetics were determined. Whole body leucine kinetics and tissue fractional protein synthetic rates (FSR, percent per day) were estimated using a four-hour constant intravenous infusion of L-[1-14C]leucine on day 3. The group of rats enterally fed MDF lost less body weight than the other groups (P less than or equal to .05). MDF and Captex 810B produced a positive and significantly greater (P less than or equal to .05) daily and cumulative nitrogen balance than either LCT or MCT. Oxygen consumption (P less than or equal to .05) and total energy expenditure (P less than or equal to .05) were elevated approximately 22% with MDF as compared with LCT or MCT. Rectus muscle FSR and absolute rate of protein synthesis were increased 19% with MDF (P less than or equal to .05) as compared with LCT or MCT.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S J DeMichele
- Nutrition/Infection Laboratory, New England Deaconess Hospital, Harvard Medical School, Boston, MA 02215
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