With the advances in technology stable fat emulsions containing medium-chain triglycerides (MCT) became available. Intravenous MCT are readily utilizable energy source because they reach the liver rapidly and their medium-chain fatty acids (MCFA) are oxidized through carnitine-independent mechanisms. However the MCFA can also be deviated to alternative oxidation pathways which results in urinary excretion of metabolites. The metabolic effects of intravenous MCT containing fat emulsions are discussed and emphasis is given in the possible role of these fats in parenteral nutrition of preterm infants, who are carnitine depleted. Directions of future research are speculated. (Journal of Parenteral and Enteral Nutrition13:312-317, 1989)
Get full access to this article
View all access options for this article.
References
1.
Filler RM, Eraklis AJ: Care of the critically ill child: Intravenous alimentation. Pediatrics46:456-461, 1970
2.
Hallberg D.: Studies on the elimination of exogenous lipids from the blood stream. The kinetics for the elimination of a fat emulsion studied by single injection technique in man. Acta Physiol Scand64:306-313, 1965
3.
Friedman Z., Marks KH, Maisels MJ, et al: Effect of parenteral fat emulsion on the pulmonary and reticuloendothelial systems in the newborn infant. Pediatrics61:694-698, 1978
4.
Nordenstrom J., Jarstrand C., Wiernick A.: Decreased chemotactic and random migration of leukocytes during Intralipid infusion. Am J Clin Nutr32:2416-2422; 1979
5.
Pereira GR, Fox WW, Stanley CA, et al: Decreased oxygenation and hyperlipemia during fat infusions in premature infants. Pediatrics66:26-30, 1980
6.
Andrew G., Chan G., Schiff D.: Lipid metabolism in the neonate. II. The effect of Intralipid on bilirubin binding in vitro and in vivo. J Pediatr88:279-284; 1976
7.
Yeh YY, Cooke RJ, Zee P.: Impairment of lipid emulsion metabolism associated with carnitine insufficiency in premature infants. J Pediatr Gastroenterol Nutr4:795-798, 1985
8.
Griffin E., Breckenridge WC, Kuksis A., et al: Appearance and characterization of lipoprotein X during continuous Intralipid infusion in the neonates. J Clin Invest64:1703-1712, 1979
9.
Eckart J., Adolph M., Van dr Muhlen V., Naab V.: Fat emulsions containing medium-chain triglycerides in parenteral nutrition of intensive care patients. JPEN4:360-366, 1980
10.
Sailer D., Muller M.: Medium-chain triglycerides in parenteral nutrition. JPEN5:115-119, 1981
11.
Crowe PJ, Dennison AR, Royle GT: 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. JPEN9:720-724, 1985
12.
Mott CT, Sarles H., Tiscornia O.: Action difference des triglycerides a chaines courtes, moyennes ou lougnes sur la secretion pancreatique exocrine de l'homme. Biol Gastroenterol5:79-84, 1972
13.
Tandon RK, Rodgers JB, Balint JA: The effects of medium-chain triglycerides in the short bowel syndrome. Increased glucose and water transport. Am J Dig Dis17:233-238, 1972
14.
Tantibhedhyangkul P., Hashim SA: Medium-chain triglyceride feeding in premature infants: Effects of fat and nitrogen absorption. Pediatrics55:359-369, 1975
15.
Hashim SA: Studies of medium-chain fatty acid transported in portal blood. In Medium-Chain Triglycerides, JR Senior (ed). University of Pennsylvania Press. Philadelphia, 1968, pp. 81-90
Ashbrook JD , Spector AA, Fletcher JE: Medium-chain fatty acid binding to human plasma albumin. J Biol Chem247:7038-7042, 1972
18.
Scheig R.: Hepatic metabolism of medium-chain fatty acids. IN Medium-Chain Triglycerides, JR Senior (ed). University of Pennsylvania Press. Philadelphia, 1968, pp 39-49
19.
Gurr MI, James AT: Fatty Acids. IN Lipid Biochemistry, An Introduction , 3rd ed, Gurr and James (eds). Chapman and Hill, London, 1980, pp 18-42
20.
Osumi T., Hashimoto T.: Acyl CoA oxidase of rat liver: A new enzyme for fatty acid oxidation . Biochem Biophys Res Commun83:479-485, 1978
21.
Fritz JB: Action of carnitine on long-chain fatty acid oxidation by liver. Am J Physiol197:297-304, 1959
22.
Bressler R. , Wittels B.: The effect of diphteria toxin on carnitine metabolism in the heart. Biochim Biophys Acta104:39-45, 1965
23.
Bach AC, Phan T., Metails P.: Effect of the fatty acid composition of ingested fats on rat liver intermediary metabolism. Horm Metab Res8:375-379, 1976
24.
Schwabe AD, Cozzeto FJ, Bennett LR, Mellinkoff SM: Estimation of fat absorption by monitoring of expired radioactive carbon dioxide after feeding a radioactive fat. Gastroenterology42:285-291, 1962
25.
Bach AC: Oxaloacetate deficiency in MCT-induced ketogenesis. Arch Int Physiol Biochim86:1133-1142; 1978
26.
Tantibhedhyangkul P., Hashim SA, Van Itallie TB: Effects of ingestion of long-chain and medium-chain triglycerides on glucose tolerance in man. Diabetes16:769-779, 1967
27.
Guisard D., Debry G.: Metabolic effects of a medium-chain triglyceride emulsion injected intravenously in man. Horm Metab Res4:509, 1972
28.
Yeh YY, Zee P.: Relation of ketosis to metabolic changes induced by acute medium-chain triglyceride feeding in rats. J Nutr196 :58-67, 1976
29.
Bach AC, Schirarein H., Bauer M., Weryha A.: Ketogenesis response to medium-chain triglyceride load in the rat . J Nutr107 :1863-1870, 1977
30.
Cahill GR: Ketosis. JPEN5:281-287, 1981
31.
Hahn P., Vavrouskova E.: Acetoacetate formation by livers from human fetuses aged 8-17 weeks . Biol Neonate7:48-352, 1964
32.
Sabata V., Wolf H., Lausman S.: The role of free fatty acids, glycerol, ketone bodies, and glucose in the energy metabolism of the mother and fetus during delivery. Biol Neonate13:7-17, 1968
33.
Kim YJ, Felig P.: Maternal and amniotic fluid substrate levels during caloric deprivation in human pregnancy. Metabolism21:507-512; 1972
34.
Schambaugh GE : Ketone body metabolism in the mother and fetus . Fed Proc44:2347-2351, 1985
35.
Paterson P., Sheath J., Taft P., Wood C.: Maternal and fetal ketone concentrations in plasma and urine. Lancet1:862-865, 1967
36.
Lucas A., Boyes S., Bloom SR, Aynsley-Green A.: Metabolic and endocrine responses to a milk fed in 6-day old term infants: Differences between breast and cow's milk formula feeding. Acta Paediatr Scand70:195-200, 1981
37.
Hawkins RA, Williamson DH, Krebs HA: Ketone body utilization by adult and suckling rat brain in vivo. Biochem J122:13-18, 1971
38.
Persson B., Settergren G., Dahlquist G.: Cerebral arteriovenous difference of acetoacetate and D-beta-hydroxybutyrate in children. Acta Paediatr Scand61:273-278, 1972
39.
Edmond J., Avestad N., Robbins RA, Bergstrom JD: Ketone body metabolism in the neonate: Development and the effect of diet . Fed Proc44:2359-2364, 1985
40.
Edmond J.: Ketone bodies as precursors of steroids and fatty acids in the developing rat. J Biol Chem249:72, 1974
41.
Wu PYK , Edmond J., Avestad N., et al: Medium-chain triglycerides in infants formulas and their relation to plasma ketone body concentrations. Pediatr Res20:338-341, 1986
42.
Gregersen N. , Mortensen PB, Kolvraa S.: On the biologic origin of C6-C10 dicarboxylic and C6-C10 omega-1 hydroxy monocarboxylic acids in human and rat with acyl-CoA dehydrogenation deficiencies : In vitro studies on the omega- and omega-1 oxidation of medium chain (C6-C12) fatty acids in human and rat liver. Pediatr Res17:828-834, 1983
43.
Mantagos S. , Genel M., Tanaka K.: Ethylmalonic adipic aciduria: In vivo and in vitro studies indicating deficiency of activities of multiple acyl-CoA dehydrogenase. J Clin Invest64:1580-1589, 1979
44.
Mortensen PB : Dicarboxylic acids and the lipid metabolism . Dan Med Bull31:121-145, 1984
45.
Verkade PE, Lee J.: Researches of fat metabolism II. Biochem J28:31-40, 1934
46.
Mortensen PB , Gregersen N.: Medium-chain triglyceride medication as a pitfall in the diagnosis of nonketotic C6-C10 dicarboxylic acidurias . Clin Chim Acta103:33-37, 1980
47.
Whyte RK, Whelan D., Hill R., McClorry S.: Excretion of dicarboxylic and omega-1 hydroxy fatty acids by low birth weight infants fed with medium-chain triglycerides. Pediatr Res20:122-125, 1986
Dupont C., Rocchioccioli F., Bougneres PF: Urinary excretion of dicarboxylic acids in term newborns fed with 5% medium-chain triglycerides-enriched formula. J Pediatr Gastroenterol Nut6:313-314, 1987
50.
Lima LAM , Losty H., Gray OP: Excretion of dicarboxylic acids following administration of medium-chain triglycerides . JPEN11:600-601, 1987
51.
Bohles H., Akcetin Z., Leanert W.: The influence of intravenous medium- and long-chain triglycerides and carnitine on the excretion of dicarboxylic acids. JPEN11:46-48. 1987
52.
Kuhara T., Matsumoto I., Ohmo M.: Identification and quantification of octanoyl glucuronide in the urine of children who ingested medium-chain triglycerides. Biomed Mass Spectrom13:595-598, 1986
53.
Bach AC, Babayan VK: Medium-chain triglycerides. An update. Am J Clin Nutr36:950-962, 1982
54.
Sarda P., Lepade G., Roy CC, Chessex P.: Storage of medium-chain triglycerides in adipose tissue of orally fed infants . Am J Clin Nutr45:399-405, 1987
55.
Blackburn G. , Babayan V.: Medium-chain triglycerides storage in fed infants (lettr). Am J Clin Nutr46:862-863, 1987
56.
Putet G., Thelin A., Arnaud MJ, et al: Oxidative metabolism of 13C medium-chain triglyceride fed to preterm infants. Pediatr Res18:344, 1984
57.
Van Aerde J. , Sauer P., Heim T., et al: The effect of diet composition on metabolism, substrate utilization, and growth in the VLBW infant. Pediatr Res19:1085, 1985
58.
Cotter R., Taylor CA, Johnson R., et al: A metabolic comparison of a pure long-chain triglyceride emulsion (LCT) and various medium-chain triglyceride (MCT)-LCT combination emulsion in dogs. Am J Clin Nutr45:927-939, 1987
59.
Yamazaki K. , Maiz A., Sobrado J., et al: Hypocaloric lipid emulsions and aminoacid metabolism in injured rats. JPEN8:361-366, 1984
60.
Beaufrere B. , Tessari P., Cattalini M., et al: Apparent decreased oxidation and turnover of leucine during infusion of medium-chain triglycerides . Am J Physiol (Endocrinol Metab 12) E175-E182, 1985
61.
Stein TP, Prest ME, Leskiw MJ, et al: Comparison of glucose, LCT, and LCT plus MCT as calorie sources for parenterally nourished rats. Am J PhysiolE277-E287; 1984
62.
Hamawy KJ, Moldawer LL, Georgieff M., et al: The effect of lipid emulsions on reticuloendothelial system function in the injured animal. JPEN9:559-565, 1985
63.
Sobrado J., Moldawer LL, Pomposelli JJ, et al: Lipid emulsions and reticuloendothelial system function in healthy and burned guinea pigs. Am J Clin Nutr42:855-863, 1985
64.
Paust H., Knoblach G., Park W., et al: Fatty acid utilization of MCT containing fat emulsion in newborn infants (abstr). Pediatr Res20:1038, 1986
65.
Kolb S., Sailer D.: Effect of fat emulsions containing medium-chain triglycerides and glucose on ketone body production and excretion. JPEN8:285-289, 1984
66.
Dennison AR , Ball M., Crowe, PJ, et al: The metabolic consequences of infusing emulsions containing medium-chain triglycerides for parenteral nutrition: A comparative study with conventional lipid. Ann R Coll Surg Engl68:119-121, 1986
67.
Lima LAM , Murphy JF, Stansbie D., et al: Neonatal parenteral nutrition with a fat emulsion containing medium-chain triglycerides. Acta Paediatr Scand77:332-339, 1988
68.
Kushner RF: Total parenteral nutrition-associated metabolic acidosis. JPEN10:306-310, 1986
69.
Bach AC, Guisard D., Debry G., Metais P.: Metabolic effects following a medium-chain triglycerides load in dogs. V. Influence of the perfusion rate. Arch Int Physiol Biochim82:705-719, 1974
70.
Ball MJ, Sear JW: Intravenous feeding with medium-chain triglycerides. Effect on blood gases and the complement system in critically ill patients. Anaesthesia41:423-426, 1986
