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[A comparative study of fat emulsions clearance test using long chain triglycerides and medium chain triglycerides in volunteers].

Intravenous fat emulsions clearance test using long chain triglycerides (LCT) and medium chain triglycerides (50% MCT/LCT) were studied in ten healthy chinese volunteers. In the morning (8:00 AM) the lipid was infused continuously for 5 hours at rate of 0.17g.kg-1/h. There was an interval of two weeks between LCT and MCT/LCT. The peak concentration of serum triglyceride was smaller in MCT group. The area under concentration curve had significant difference between LCT and MCT groups (6108 +/- 461 vs 4495 +/- 362, P < 0.05). The serum free fatty acid was 628 +/- 42 in LCT and 1049 +/- 1 in MCT respectively in 5 hour (P < 0.001). The concentrations of very low-density lipoprotein (VLDL) in serum were increased in volunteers receiving LCT and MCT, but those of LDL and HDL were decreased. The blood sugar and cholesterol had no significant difference after lipids infusions. The study demonstrated that medium chain triglycerides was faster to be cleared than long chain triglycerides.

Adult↗

Polymorphisms in the insulin response element of APOC-III gene promoter influence the correlation between insulin and triglycerides or triglyceride-rich lipoproteins in humans.

OBJECTIVE: To assess whether the -455 and -482 mutations in APOC-III gene insulin response element affect the relationships between plasma insulin and triglyceride-rich lipoprotein levels. DESIGN: Population-based studies. SUBJECTS: The population sample was composed of 983 subjects (485 men and 498 women), aged between 35 and 65 y, randomly sampled from the electoral rolls in Northern France and stratified on gender and 10 y age groups. MEASUREMENTS: Plasma triglyceride, apolipoprotein C-III, apoB, LpC-III:B and LpE:B lipoprotein particles and insulin levels were measured. Two polymorphisms in APOC-III gene insulin response element (T-->C at -455 and/or C-->T at -482) were determined. RESULTS: Plasma insulin was positively correlated to triglyceride levels (P<0.0001), apo C-III (P<0.003), LpC-III:B (P<0.0001), apoB (P<0.0001) and LpE:B (P<0.0001). This association differed significantly according to APOC-III insulin response element polymorphisms. The relationship between insulin and LpC-III:B (P<0.02) or apoB (P<0.02) was greater in women bearing the C allele of -455 than the T allele. Similarly, the relationship between insulin and LpC-III:B (P<0.02) or LpE:B (P<0.05) was greater in women bearing the T allele of -482 than the C allele. There was no evidence for any effect in men. CONCLUSION: These results suggest that the relationship between plasma insulin and triglyceride-rich lipoprotein levels is partly influenced by polymorphisms in APOC-III insulin response element.

Adult↗

Comparison of the efficacy of medium chain triglycerides with long chain triglycerides in total parenteral nutrition in patients with hematologic malignancies undergoing peripheral blood stem cell transplantation.

BACKGROUND AND AIMS: The purpose of this randomized study was to compare the efficacy of medium chain triglycerides (MCT) plus long chain triglycerides (LCT) with LCT alone in total parenteral nutrition (TPN) solutions in patients with various hematologic malignancies who underwent a hematopoietic peripheral blood stem cell (PBSC) transplantation. METHODS: Of 36 patients entering into this study, 18 received MCT + LCT (group I) and the remaining 18 received LCT alone (group II) in TPN solutions. Patients were comparable regarding age, gender, donor-recipient gender, diagnosis, body weights, blood group differences and number of infused CD34(+) cells/kg. Post - transplant parameters such as duration of platelet and neutrophil engraftment, coagulation parameters, number of days of febrile neutropenia and antibiotic administration, plasma glucose, triglyceride, cholesterol and albumin levels, graft-versus-host disease (GVHD) and first 100 day mortality were compared in both groups. RESULTS: Median days of neutrophil >0.5 x 10(9)/l and platelet of >20 x 10(9)/l in group I and group II were 15 (range, 8-21), 11 (10-29) and 14 (range, 9-31), 13 (9-18) respectively (P>0.05). Median days of febrile neutropenia in group I and II were 10 (range, 4-23) and 7 (2-13) respectively (P=0.01). Median days of antibiotic administration in group I and II were 12 (range, 6-22) and 8 (4-25) respectively (P=0.04). Pre, peri- and post-transplant coagulation parameters such as PT, aPTT, and fibrinogen did not differ significantly between two groups (P>0.05), as well as plasma glucose, triglyceride, cholesterol, albumin levels, GVHD and first 100 day mortality. CONCLUSION: There was no difference between patients receiving MCT + LCT (group I) and LCT alone (group II) in TPN solutions regarding duration of engraftment and coagulation parameters, but numbers of median days of febrile neutropenia and days of antibiotic administration were significantly shorter in patients receiving LCT alone (group II) than those receiving MCT + LCT (P<0.01 and 0.04 respectively).

Adolescent↗

Effect of medium-chain triglycerides on the postprandial triglyceride concentration in healthy men.

This study compared the serum lipid concentrations after a single dose of medium-chain triglycerides (MCT) or long-chain triglycerides (LCT) between individuals grouped according to the body mass index (BMI). Twenty-five males participated as volunteers, the test diet containing 10 g of MCT or LCT. Blood samples were collected up to 6 h after the intake of a test diets. The LCT diet resulted in significantly greater increases in areas under the curves (AUCs) for serum and chylomicron triglyceride in the BMI > or = 23 kg/m2 group than those in the BMI < 23 kg/m2 group. The magnitude of response after intake of the MCT diet by the BMI > or = 23 kg/m2 group was significantly lower than that after the LCT diet. These results suggest that, in subjects with BMI > or = 23 kg/m2, the intake of MCT is preferable to that of LCT for maintaining postprandial triglyceride at a low concentration.

Animals↗

Hepatic overexpression of microsomal triglyceride transfer protein (MTP) results in increased in vivo secretion of VLDL triglycerides and apolipoprotein B.

The microsomal triglyceride transfer protein (MTP) is essential for the hepatic secretion of apolipoprotein (apo) B-containing lipoproteins. Previous studies have indicated that inhibition of MTP results in decreased apoB plasma levels and decreased hepatic triglyceride secretion. However, the metabolic effects of overexpression of MTP have not been investigated. We constructed a recombinant adenovirus expressing MTP (AdhMTP) and used it to assess the effects of hepatic overexpression of MTP in mice. Injection of AdhMTP into C57BL/6 mice resulted in a 3-fold increase in hepatic microsomal triglyceride transfer activity compared to mice injected with Adnull. On day 4 after virus injection, AdhMTP-injected mice had significantly elevated plasma TG levels as compared to control virus (Adnull)-injected mice. Hepatic TG secretion rates were significantly greater in AdhMTP-injected mice (184 +/- 12 mg/kg/h) compared with Adnull-injected mice (65 +/- 9 mg/kg/h, P < 0.001). In addition, hepatic very low density lipoprotein (VLDL) apoB secretion in the AdhMTP-injected group was 74% higher than in the control virus group. Hepatic secretion of apoB-48 and apoB-100 contributed equally to this increase. These results provide the first data that hepatic overexpression of MTP results in increased secretion of VLDL-triglycerides as well as VLDL-apoB in vivo. These results suggest that MTP is rate-limiting for VLDL apoB secretion in wild-type mice under basal chow-fed conditions.

Animals↗

Atherogenic nature of triglycerides, postprandial lipidemia, and triglyceride-rich remnant lipoproteins.

In addition to low-density lipoproteins, plasma chylomicrons and very-low-density lipoproteins (VLDL) contribute to atherogenesis. When triglyceride-rich particles bind to arterial endothelium and to deendothelialized areas, locally present lipoprotein lipase initiates triglyceride hydrolysis and decreases the size of the adhering particles. Additional changes in composition are brought about by the exchange of lipids between chylomicron/VLDL remnants and the cholesteryl ester-rich low- and high-density lipoproteins. These exchanges are mediated by lipid transfer proteins in plasma. Animal studies with doubly labeled lipoproteins show that the size of lipoprotein particles determines their rate of entering the artery and contributes to the formation of lesions. This model supports epidemiologic studies that have identified plasma triglycerides as a risk factor for atherogenesis. The model for a causal role of pre- and postprandial triglyceride-rich lipoproteins in atherogenesis suggests that measuring them may improve the assessment of cardiovascular risk factors.

Adult↗

Glycerol kinetics with parenteral lipid emulsions (long-chain triglycerides, medium-chain triglycerides, and structured lipids) in rats.

Several studies have reported that parenteral lipid emulsions containing medium-chain triglycerides (MCT) and structured lipids (SL) are better utilized than those containing long-chain triglycerides (LCT). The objective of this study was to test the hypothesis that parenteral LCT require more extensive modification via hydrolysis and reesterification (triglyceride-free fatty acid [TG-FFA] recycling) for effective utilization, whereas MCT and SL do not. As an index of TG-FFA cycling activity, we measured glycerol and palmitate kinetics in rats (204 to 243 g) fed parenterally one of three isocaloric (250 kcal/kg/d) isonitrogenous (1.5 g N/kg/d) diets with half of the nonprotein energy from glucose and the rest from either LCT, LCT plus MCT, or SL for 5 days. Two experiments were performed. On day 5, rats were given a 7-to 8-hour infusion of either 5H2 Glycerol and 1-14C Palmitate bound to albumin to measure palmitate and glycerol kinetics (experiment 1), or U-13C glucose to determine the proportion of endogenous glycerol production derived from glucose (experiment 2). Data are presented as means +/- SEM. Endogenous glycerol production was significantly higher with LCT (11.33 +/- 2.89 mmol/kg/h) than with SL (2.91 +/- 0.62 mmol/kg/h). The value for the physical mixture of LCT plus MCT (5.46 +/- 1.29 mmol/kg/h) fell midway between that for LCT and SL (P = NS). There were no significant differences in palmitate kinetics or oxidation. The increased glycerol production is due to the mobilization of endogenous triglyceride and is consistent with a higher rate of TG-FFA cycling being involved in the metabolism of LCT than of SL.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

Metabolic effects of glucose, medium chain triglyceride and long chain triglyceride feeding before prolonged exercise in rats.

The purpose of this study was to test the hypothesis that oral ingestion of lipids could increase endurance by slowing the rate of glycogen depletion. Trained rats were killed after a 2 h run on a rodent treadmill, following an intragastric infusion of water, glucose, medium chain triglycerides (MCT) or long chain triglycerides (LCT). Glucose and triglycerides were administered in equicaloric concentrations (50 kJ). The results show that oral ingestion of lipids (MCT or LCT) did not reduce glycogen depletion in liver, heart or skeletal muscle after exercise whereas the fat diet increased muscle and heart glycogen stores in resting conditions. In contrast, glucose feeding induced a significant sparing effect on endogenous carbohydrate utilization and reduced physical exercise lipolysis. These data indicated, firstly, that enhanced lipid availability induced by a single lipid meal before exercise was not able to modify the glycogen depletion occurring after exercise and, secondly, that the glucose/fatty acid cycle was not effective in these conditions. The comparison between lipids indicated that the effect on glycogen use of MCT did not differ from that of LCT, and did not seem to be of any particular importance during physical exercise.

3-Hydroxybutyric Acid↗

Positional analysis of isovaleroyl triglycerides using proton magnetic resonance with Eu(fod)3 and Pr(fod)3 shift reagents: II. Cetacean triglycerides.

The positional distribution of isovaleric acid in natural cetacean triglycerides has been studied using proton magnetic resonance with lanthanide shift reagents. Twenty-nine samples of melon, jaw, and blubber triglycerides from 13 genera in the Delphinidae, Phocoenidae, and Monodontidae families were examined. Isovaleric acid was found esterified only at the 1,3-positions in the monoisovaleroyl and diisovaleroyl triglycerides of these animals.

Adipose Tissue↗

Constant infusion rates of lipid emulsions to stabilize plasma triglyceride concentrations: medium-chain triglyceride/long-chain triglyceride emulsions (MCT/LCT) versus LCT.

As medium-chain triglyceride emulsions (MCT) are more rapidly hydrolyzed than long-chain triglyceride emulsions (LCT), MCT/LCT tends to be infused faster than LCT. The purpose of the present study was to determine the most appropriate infusion rate for MCT/LCT to stabilize plasma concentrations of triglyceride (TG), being equivalent to the optimal infusion rate of the emulsion. A TG clamp was set up by raising the mean +/- SD concentrations of TG in plasma, being 1.08 +/- 0.18 delta mmol l(-1) for LCT, and 1.65 +/- 0.31 delta mmol l(-1) for MCT/LCT after a 50-min priming infusion of each emulsion. Thereafter, the infusion rate of lipid was controlled every 10 min to maintain a steady concentration of TG for a period of 150 min. A constant infusion of glucose at 0.32 g/kg body weight (BW) per h was administered for the test period. The weight-based rate of the infusion to maintain a steady state of plasma TG concentrations did not differ between MCT/LCT and LCT, being 0.125 +/- 0.013 vs 0.117 +/- 0.021 g/kg BW per h, while the molar-based infusion rate was 0.203 +/- 0.021 mmol/kg BW per h for MCT/LCT and 0.132 +/- 0.023 mmol/kg BW per h for LCT (P < 0.05). These results suggest that although 54% more molar MCT/LCT-TG can be hydrolyzed during a constant infusion, MCT/LCT should not be infused at a rate faster than 0.1 g/kg BW per h under a steady state.

Fat Emulsions, Intravenous↗

Diurnal triglyceride profiles: a novel approach to study triglyceride changes.

Fasting plasma triglycerides (TG) show a high intra-individual variability, and therefore, repeated measurements and alternative methodology are necessary when studying TG metabolism. In search for novel approaches to study TG changes, we evaluated the feasibility of determining ambulatory capillary TG. In addition, well-known characteristics (e.g. gender differences) of TG metabolism in healthy subjects were determined. In 18 subjects with a wide range of fasting plasma TG, the results of standardised oral fat loading tests (50 g m(-2)) were compared to their diurnal capillary TG profiles, measured on 3 different days, six times each day in an out-patient clinic setting. The diurnal TG-profile was calculated as area under the capillary TG curve (TGc-AUC) and as incremental area (dTGc-AUC). Clearance of plasma TG after the acute oral fat load correlated well with the diurnal TGc-AUC (r=0.77; P<0.01). In addition, hypertriglyceridemic subjects (plasma TG >2.0 mmol l(-1)) had a higher diurnal triglyceridemia (49.83+/-15.37 h mmol l(-1)) as well as a higher response of plasma TG to the oral fat load (42.10+/-15.37 h mmol l(-1)), than the subjects with normal fasting plasma TG (29.83+/-11.75 h mmol l(-1) (P<0.05) and 20.75+/-5.89 h mmol l(-1) (P<0.01), respectively). In an observational study, 106 volunteers (54 females and 52 males) measured capillary triglycerides. Food intake was recorded and fasting blood was drawn once at the start of the study. Body composition was assessed by anthropometric parameters and body-impedance. Repeated measurements of diurnal triglyceridemia tended to be less variable than fasting capillary triglycerides (mean coefficients of variation 15.1% (range: 0.60-45.9%) and 24.9% (range: 1.44-72.7%), respectively; P=0.09) for the whole group and in males (18.6% (0.60-45.9%) and 24.0% (1.4-58.2%), respectively; P=0.07). The mean diurnal TGc-AUC and dTGc-AUC were lower in females (16.50+/-4.85 and 1.82+/-3.46 h mmol l(-1), respectively) than in males (23.44+/-6.50 and 6.93+/-4.67 h mmol l(-1); P<0.001 for each). The total daily energy intake was lower in females (8911+/-1905 kJ) than in males (11042+/-2604 kJ, P<0.001) because of a lower intake of all nutrients. In females, estrogen status determined significantly the capillary TG profiles. Stepwise multiple regression analysis for females and males, with TGc-AUC as the dependent variable, showed that the best predictors were fasting capillary TG, gender, systolic blood pressure and mean daily energy intake, explaining 72% of the variation. Incremental triglyceridemia was best described by gender, mean daily protein intake and systolic blood pressure, explaining 42% of the variation. Diurnal capillary TG profiles may be used to estimate the total daily load of potential atherogenic particles to which individuals are subjected during the day without the need for metabolic ward studies.

Adult↗

Comparison of the fat elimination between long-chain triglycerides and medium-chain triglycerides in rats with ischemic acute renal failure.

To guide the administration of fat emulsion in the nutritional support of acute renal failure (ARF), pharmacokinetic analysis with an one-compartment open model after bolus intravenous injection was performed to compare the elimination kinetics of long-chain triglycerides (LCT) and medium-chain triglycerides (MCT) in ischemic acute renal failure rats. Sprague-Dawley rats were randomized into four groups, namely LCT normal group, LCT ARF group, MCT normal group and MCT ARF group. The model of ischemic acute renal failure was induced by clamping the left renal artery for 60 min and contralateral nephrectomy. All the rats were fasted with water ad libitum for 10 h before 0.3 g/kg body weight of 10% Intralipid (LCT) or 10% Lipofundin (MCT: LCT = 50:50) was injected as a bolus to them via the tail vein. The serum triglyceride concentration was determined at 2, 10, 40, 70, 100, 130 and 160 min after intravenous injection for kinetic analysis. The results showed that the elimination rate constant (ke) of LCT ARF group was significantly decreased, while the half life period (t1/2) of it was significantly longer than those of LCT normal group. The ke and t1/2 of MCT showed no statistical difference between normal and ARF groups. In the normal group the ke of LCT was significantly decreased compared with MCT whereas the t1/2 was significantly prolonged. In the ARF group the ke of LCT was much less than that of MCT while the t1/2 was much longer. The serum insulin levels of both MCT groups were significantly higher than those of LCT groups. These results indicate that MCT will be eliminated more rapidly than LCT in ARF rats. MCT may also increase the secretion of insulin. In conclusion, MCT may be more favorable than LCT in the nutritional management of ARF.

Acute Kidney Injury↗

Competitive effects of long-chain-triglyceride emulsion on the metabolism of medium-chain-triglyceride emulsions.

This study was conducted to assess the potential metabolic competitive interactions of intravenous medium-chain-triglyceride (MCT) and long-chain-triglyceride (LCT) lipid emulsions. To assess this competition increasing concentrations of LCT emulsion were added to an intravenous dose of MCT emulsion of 3.0 g/kg body wt up to a maximum dose of 3.0 g LCTs/kg body wt. Blood samples were assessed for competitive interactions by analyzing the following metabolites: glucose, insulin, lactate, pyruvate, ketones (acetoacetate, beta-hydroxybutyrate), elimination of triglycerides, and free fatty acids. Evaluation of the data showed a strong competitive interaction between the MCT and LCT emulsions. This competition was evident as soon as LCTs were added to the MCT infusions and appeared to favor LCTs for removal and metabolism over MCTs. This appears to indicate that there is a peripheral, strong affinity site for LCT removal and metabolism and a shared peripheral site and specific visceral site for MCT removal and metabolism.

Animals↗

Hematological and biochemical effects of parenteral nutrition with medium-chain triglycerides: comparison with long-chain triglycerides.

Twenty-four malnourished patients requiring total parenteral nutrition were randomly assigned to receive a daily infusion of either Lipofundin MCT-LCT [a new lipid preparation containing medium-chain triglycerides (MCTs)], or Lipofundin S [a long-chain triglyceride (LCT) preparation] for 6-28 d. No adverse clinical effects were apparent in patients receiving the new emulsion. Hematological indices were unchanged. Plasma urea concentrations rose less on MCT-LCT than on LCT and the plasma bilirubin concentration was lower. Plasma ketones were higher immediately after the MCT-LCT infusion but not at other times. Triglyceride and fatty acid concentrations were similar. Insulin concentrations were higher on MCT-LCT than on LCT. Daily nitrogen balance values were not significantly different between the two groups. Urinary carnitine excretion fell dramatically on both lipids.

Bilirubin↗

Triglycerides in fish oil affect the blood clearance of lipid emulsions containing long- and medium-chain triglycerides in mice.

Lipid emulsions containing long-chain triglycerides (LCT) and medium chain triglycerides (MCT) are widely used in parenteral nutrition. Recently, fish oil (FO) triglyceride (TG)-derived emulsions are considered therapeutic because of their many beneficial biological modulatory actions. We investigated in mice whether adding 10% FO to an intravenous lipid emulsion with MCT and LCT (MCT:LCT:FO -50:40:10% by wt) would affect particle blood clearance and tissue targeting in comparison to LCT (100% by wt) and MCT:LCT (50:50% by wt) emulsions. The 3 emulsions were labeled with [3H] cholesteryl oleoyl ether and administered by bolus injection (400 microg TG/mouse) to C57BL/6J mice. Contributions of LDL receptor (LDL-R) and LDL-R-related protein to emulsion catabolism were assessed using LDL-R-deficient mice and preinjection of lactoferrin, and the effects of lipoprotein lipase (LPL) were determined by preinjection of heparin and Triton WR 1339. Although fractional catabolic rates did not differ among the 3 emulsions, blood removal at each time point after injection was greater for MCT:LCT:FO particles due to their higher initial margination volume. Compared with MCT:LCT and LCT emulsions, patterns of tissue uptake of the MCT:LCT:FO emulsions were different, e.g. MCT:LCT:FO emulsion particle uptake was lower in heart, adipose tissue, and muscle, and higher in lung, and the removal of MCT:LCT:FO emulsion particles was less dependent on LPL, LDL-R, and lactoferrin-sensitive pathways. These data suggest that the addition of a low percentage of FO to MCT:LCT emulsions substantially changes their particle clearance and tissue uptake mechanisms.

Animals↗

Common polymorphism in promoter of microsomal triglyceride transfer protein gene influences cholesterol, ApoB, and triglyceride levels in young african american men: results from the coronary artery risk development in young adults (CARDIA) study.

The microsomal triglyceride transfer protein (MTP) plays a key role in the assembly of apolipoprotein B (apoB)-containing lipoproteins. We investigated the relation between lipid profiles and a common functional polymorphism (-493G/T) of the MTP gene in a large sample of young black men in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We performed serial cross-sectional analyses on lipids of 586 black men in 5 exams over 10 years of follow-up. Total cholesterol, LDL cholesterol, and apoB levels were very similar between the GT and GG genotypes; therefore, the GT and GG genotypes were combined as 1 group when the 3 phenotypes were analyzed. The results from ANCOVA showed that the TT group (prevalence 7%) had higher levels of apoB-related lipids than did the GT+GG group: the difference in total cholesterol ranged from 2 (P=0.79) to 19 (P=0.002) mg/dL in exams 1 to 5; the difference in LDL cholesterol ranged from 10 (P=0.14) to 17 (P=0.003) mg/dL in exams 1 to 4, but in examination 5, the difference became negligible. The TT group had higher levels of apoB, measured in only 2 exams, by 6 (P=0.12) and 9 (P=0.03) mg/dL. The TT group had higher levels of triglycerides than did the TG or GG group by 3 to 34 (P=0.02 to approximately 0.003) mg/dL in all 5 exams. HDL cholesterol and apolipoprotein A-I levels were similar among the 3 genotypes. Our serial cross-sectional analyses indicated that the TT genotype was associated with higher levels of total cholesterol, LDL cholesterol, triglycerides, and apoB in young black men. The broad effect of this polymorphism on several atherogenic traits suggests that the MTP gene could be influential in atherosclerosis.

Adolescent↗

Influence of lysophosphatidylcholine on the C-apolipoprotein content of rat and human triglyceride-rich lipoproteins during triglyceride hydrolysis.

Remnants produced from rat chylomicrons in hepatectomized rats or from human chylomicrons by incubation in postheparin plasma contained much less C-apolipoproteins, but more lysophosphatidylcholine than the parent chylomicrons. A phospholipid-triglyceride emulsion absorbed C-apolipoproteins during incubation in serum, yet not in postheparin plasma, which led to lipid-hydrolysis and increased in lysophosphatidylcholine. The fraction d = 1.006-1.019 g/ml of human serum comprised more lysophosphatidylcholine and less C-apolipoproteins than the fraction d less than 1.006 g/ml. Injection of heparin induced hydrolysis with an increase in lysophosphatidylcholine and loss of C-apolipoproteins in both fractions. These inverse changes of lysophosphatidylcholine and C-apolipoproteins during lipid-hydrolysis suggest a causal relationship, which is strongly supported by the induction of loss of C-apolipoproteins from rat chylomicrons and human triglyceride-rich lipoproteins by addition of lysophosphatidylcholine in vitro. Apolipoprotein C-II was more affected than C-III. These results may elucidate a mechanism for the regulation of the termination of the triglyceride hydrolysis and the final hepatic uptake of remnants.

Animals↗

A new intravenous emulsion containing medium-chain triglyceride: studies of its metabolic effects in the perioperative period compared with a conventional long-chain triglyceride emulsion.

The effects of carbohydrate, lipid, and nitrogen metabolism of recently available lipid emulsions containing either 50% medium-chain triglyceride (MCT) and 50% long-chain triglyceride (LCT) or 100% LCT were compared in elective surgical patients. Postoperative urinary urea excretion was similar during isocaloric MCT/LCT and LCT infusions (1.9 mg/kg/min) and was decreased compared with a standard infusion of 5% glucose (1 mg/kg/min). Plasma glucose and insulin concentrations were similar during both lipid and low dose glucose infusions. However, plasma triglyceride and nonesterified fatty acid concentrations were decreased during the MCT/LCT infusion compared with the LCT infusion, suggesting that the MCT/LCT emulsion was cleared from the circulation faster than pure LCT. Ketone body concentrations were similar during all three infusions. MCT/LCT emulsion can be safely infused perioperatively and has similar nitrogen conserving properties to LCT in these circumstances.

Blood Glucose↗