Low Medium Chain Triglycerides Research Articles

Dietary treatment of congenital chylothorax with skimmed breast milk

BackgroundCongenital chylothorax (CC) is a rare but potentially life-threatening condition in newborns. It is defined as an accumulation of chyle in the pleural cavity. The few publications regarding medical management and therapeutic dietary intervention motivated us to share our experience.MethodsNeonates diagnosed with congenital chylothorax and treated at Innsbruck Medical University Hospital between 2013 and 2020 (n = 6, gestational age: 36 3/7, 32 5/7, 36 4/7, 35 0/7, 35 4/7, 37 3/7 weeks) were eligible for this report.The cornerstones of treatment for chylothorax conventionally consist of chest tube drainage (CTD), respiratory support, dietary restriction of long-chain triglycerides (LCT) or total parenteral nutrition (TPN). In further course the introduction of a medium-chain triglyceride (MCT)-based formula followed by an overlapping switch to a formula with low LCT and high MCT, containing the essential long-chain fatty acids (LCFA), is attempted. In three patients we used fat-modified (skimmed) breast milk to provide a high protein and low fat diet and to avoid the discontinuation of breast milk.ResultsThe outcome of an early introduction of LCFA in the form of skimmed breast milk after resolution of chylothorax diverse. One patient had a favourable outcome, meaning no recurrence of pleural effusion, adequate weight gain and a content mother, while another patient had a relapse of pleural effusion after the administration of skimmed milk and was therefore transitioned back to Basic F® .The CC of patient 5 was difficult due to Noonan syndrome. Two weeks after the introduction of skimmed breast milk the mother wanted to stop to express breast milk, so nutrition was changed to Basic F®.ConclusionThe first-line therapy of chylothorax is a combination of respiratory stabilization and dietary modification. The use of skimmed breast milk is advisable in CC and feasible by means of a simple milk defatting procedure. It offers benefits to mothers who wish to resume breast feeding after resolution of chylothorax and has proven positive effects, above all in preterm infants as optimal nutrition with protective components superior to formula feeding. However, the nutritional analysis of the skimmed milk and the correlation to a re-accumulation of pleural fluid remains a question to be answered.

High versus low medium chain triglyceride content of formula for promoting short-term growth of preterm infants.

In-hospital growth of preterm infants remains a challenge in clinical practice. The high nutrient demands of preterm infants often lead to growth faltering.For preterm infants who cannot be fed maternal or donor breastmilk or may require supplementation, preterm formulas with fat in the form of medium chain triglycerides (MCTs)or long chain triglycerides (LCTs)may be chosen to support nutrient utilization and to improve growth.MCTs are easily accessible to the preterm infant with an immature digestive system, and LCTs are beneficial for central nervoussystem development and visual function. Both have been incorporated into preterm formulas in varying amounts, but their effects on the preterm infant's short-term growth remain unclear. This is an update of a review originally published in 2002, then in 2007. To determine the effects of formula containing high as opposed to low MCTs on early growth in preterm infants fed a diet consisting primarily of formula. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 8), in the Cochrane Library; Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R); MEDLINE via PubMed for the previous year; and Cumulative Index to Nursing and Allied Health Literature (CINAHL), on 16 September 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-RCTs. We included all randomized and quasi-randomized trials comparing the effects of feeding high versus low MCT formula (for a minimum of five days) on the short-term growth of preterm (< 37 weeks' gestation) infants. We defined high MCT formula as 30% or more by weight, and low MCT formula as less than 30% by weight. The infants must be on full enteral diets, and the allocated formula must be the predominant source of nutrition. The review authors assessed each study's quality and extracted data on growth parameters as well as adverse effects from included studies. All data used in analysis were continuous; therefore, mean differences with 95% confidence intervals were reported. We used the GRADE approach to assess the certainty of evidence. We identified 10 eligible trials(253infants) and extracted relevant growth data from 7 of these trials (136 infants). These studies were found to provide evidence of very low to low certainty. Risk of bias was noted, as few studies described specific methods for random sequence generation, allocation concealment, orblinding.We found no evidence of differences in short-term growth parameters when high and low MCT formulas were compared. As compared to low MCT formula, preterm infants fed high MCT formula showed little to no difference in weight gain velocity (g/kg/d) during the intervention, with a typical mean difference (MD) of -0.21g/kg/d (95% confidence interval (CI) -1.24 to 0.83; 6 studies, 118 infants; low-certainty evidence). The analysis for weight gain (g/d) did not show evidence of differences, with an MD of 0.00 g/d(95% CI -5.93 to 5.93;1 study,18 infants;very low-certainty evidence),finding an average weight gain of 20±5.9 versus 20±6.9 g/d for high and low MCT groups, respectively.We found that length gain showedno difference between low and high MCT formulas, with a typical MD of 0.10cm/week (95% CI -0.09 to 0.29; 3 studies, 61 infants; very low-certainty evidence).Head circumference gain also showed little to no difference during the intervention period, with an MD of-0.04 cm/week (95% CI -0.17 to0.09; 3 studies, 61 infants; low-certainty evidence). Two studies reported skinfold thickness with different measurement definitions, and evidence was insufficient to determine if there was a difference(2studies, 32infants; very low-certainty evidence).There are conflicting data (5studies) as to formula tolerance, with 4 studies reporting narrative results ofno observed clinical difference and 1 study reporting higher incidence of signs ofgastrointestinal intolerancein high MCT formula groups.There is no evidence of effect on the incidence ofnecrotizingenterocolitis(NEC), based on small numbers in two trials.Review authors found no studies addressinglong-term growth parameters or neurodevelopmental outcomes. We found evidence of very low to lowcertainty suggesting no differences among short-term growth data for infants fedlow versushigh MCT formulas. Due to lack of evidence and uncertainty, neither formula type could be concluded to improve short-term growth outcomes or have feweradverse effects. Further studies are necessary because the results from includedstudies are imprecise due to small numbers and do not address important long-term outcomes. Additional research should aim to clarify effects on formula tolerance and on long-term growth and neurodevelopmental outcomes, and should include larger study populations to better evaluate effect on NEC incidence.

Evidence of coexisting microemulsion droplets in oil-in-water emulsions revealed by 2D DOSY 1H NMR

Optimizing the macroscopic properties, shelf-life and stability of emulsion products requires a better understanding of the microstructural characteristics such as the type (nano, micro and macro) and the relative distribution of components (i.e., oil and surfactant) within the emulsion droplets. We used Diffusion-Ordered NMR Spectroscopy (DOSY NMR) to evaluate these characteristics in model oil-in-water emulsion containing Tween 80 and medium chain triglycerides (MCT). At low MCT concentrations, the solutions were transparent but from 1 to 5 wt% MCT, they became translucent then opaque. 1 wt% MCT was the upper boundary for the appearance of nanoemulsion phase. From the decays of the chemical shift signals of MCT and Tween 80, the DOSY results clearly demonstrate that the self-diffusion coefficients (D) are dependent on oil concentration. Small microemulsion droplets of almost uniform size (d = 12–22 nm) coexist with two sets of large nanoemulsion (d < 200 nm) and emulsion (d > 200 nm) droplets. The large droplets increase significantly in size with increasing MCT. The most striking result is the clear evidence for the presence of microemulsion droplets of nearly uniform size in the aqueous phase from below to above the nanoemulsion transition concentration at 1 wt% MCT.

Effect of dietary Fatty acids on human lipoprotein metabolism: a comprehensive update.

Dyslipidemia is a major risk factor for cardiovascular disease (CVD). Dietary fatty-acid composition regulates lipids and lipoprotein metabolism and may confer CVD benefit. This review updates understanding of the effect of dietary fatty-acids on human lipoprotein metabolism. In elderly participants with hyperlipidemia, high n-3 polyunsaturated fatty-acids (PUFA) consumption diminished hepatic triglyceride-rich lipoprotein (TRL) secretion and enhanced TRL to low-density lipoprotein (LDL) conversion. n-3 PUFA also decreased TRL-apoB-48 concentration by decreasing TRL-apoB-48 secretion. High n-6 PUFA intake decreased very low-density lipoprotein (VLDL) cholesterol and triglyceride concentrations by up-regulating VLDL lipolysis and uptake. In a study of healthy subjects, the intake of saturated fatty-acids with increased palmitic acid at the sn-2 position was associated with decreased postprandial lipemia. Low medium-chain triglyceride may not appreciably alter TRL metabolism. Replacing carbohydrate with monounsaturated fatty-acids increased TRL catabolism. Trans-fatty-acid decreased LDL and enhanced high-density lipoprotein catabolism. Interactions between APOE genotype and n-3 PUFA in regulating lipid responses were also described. The major advances in understanding the effect of dietary fatty-acids on lipoprotein metabolism has centered on n-3 PUFA. This knowledge emphasizes the importance of regulating lipoprotein metabolism as a mode to improve plasma lipids and potentially CVD risk. Additional studies are required to better characterize the cardiometabolic effects of other dietary fatty-acids.

Conservative Management of Postoperative Chyle Fistulas

Objectives: 1) Describe our experience in the diagnosis and conservative treatment of postoperative chyle fistulas. 2) Introduce a protocol of conservative treatment based on the volume of the chyle drainage. Methods: Over the last 10 year period, 354 neck dissections were performed in our department. Of the 354 patients, 11 (3,1%) developed postoperatively chyle leakage confirmed by biochemical analysis of the drain output. All 11 patients were managed conservatively. Treatment varied according to the volume of drain output. Patients with mean chyle leakage less than 300cc/day (7 patients) were treated with low fat diet and oral nutrition with medium chain triglycerides (MCT). In four cases, the volume of the chyle was over 300cc/day and was adequately managed with combination of total parenteral nutrition (TPN) and somatostatine. Among them, there was a single case that developed an excessive chylous drain output (3100cc) on the third postoperative day after introduction to oral feeding and was also treated conservatively with TPN and subcutaneous administration of somatostatine. Results: None of the patients required surgical intervention. In all patients the amount of chyle decreased after the first day of somatostatine implementation and was resolved successfully in the next three to six days respective to the amount. Conclusions: Conservative management based on the volume of chyle output by means of either combination of low fat diet and MCT oral intake, or combination TPN and somatostatine, may be an efficient treatment in patients with chyle fistulas.

Effects of dietary medium-chain triglycerides on plasma lipids and lipoprotein distribution and food aversion in cats

To determine possible diet aversion and lipid and lipoprotein alterations in cats fed diets containing medium-chain triglycerides (MCTs). 19 clinically normal adult female cats. Cats were assigned to 2 groups (low MCT diet [n = 10] and high MCT diet [9]) and fed the diets for 9 weeks according to metabolic body weight (100 kcal of metabolizable energy [ME] x kg(-0.67)/d). Daily consumption records and weekly body weight and body condition score (BCS) were used to adjust amounts fed and calculate daily ME factors for each cat to maintain ideal BCS. Blood samples were obtained after withholding food on days 0, 14, 28, and 56 for measurement of plasma triglyceride and total cholesterol concentrations and lipoprotein-cholesterol distributions. Repeated-measures ANOVA and Tukey multiple comparison tests were performed. No diet differences were found for food consumption, body weight, BCS, and ME factors. A significant increase in plasma triglyceride concentration was detected for the high MCT diet; however, values were within the reference ranges. No diet effects were observed for total cholesterol concentrations or lipoprotein-cholesterol distributions, although increases over time were observed. Inclusion of MCT in diets of cats did not result in feed refusal and had minimal effects on lipid metabolism. Such diets may be useful for both clinically normal cats and cats with metabolic disorders. The MCT oils are an example of a bioactive dietary lipid that may benefit feline metabolism and can serve as a useful functional food ingredient for cats.

High versus low medium chain triglyceride content of formula for promoting short term growth of preterm infants.

In-hospital growth of most very low birth weight infants remains below the 10th percentile of reference intrauterine growth curves (Ehrenkranz 1999). To improve growth, fat is added to preterm formula in the form of medium chain triglycerides (MCT) or long chain triglycerides (LCT). MCT are easily accessible to the preterm infant with an immature digestive system while LCT are important in the development of the retina and visual acuity. Both have been incorporated into preterm formulas in varying amounts, but their effect on the preterm infant's short term growth is unclear. To determine among preterm, formula fed infants, does high MCT as opposed to low MCT (high LCT) formula promote higher short term growth rates. MEDLINE (1966-2002), CINAHL (1982-2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), conference proceedings, and reference lists of articles were searched. All randomized trials comparing the effects of exclusive feeding of high versus low MCT formula (for a minimum of one week) on the short term growth of healthy, preterm infants. Two reviewers assessed each study's quality and extracted data on growth parameters as well as adverse effects from included studies. All data used in analysis were continuous, and therefore weighted mean differences with 95% confidence intervals were reported. Eight randomized trials studying a total of 182 infants were included. There was no evidence of difference in short term growth parameters when high and low MCT formulas were compared. The meta-analysis of weight gain based on five studies yielded a WMD of -0.35 g/kg/d (95% CI -1.44, 0.74). Similarly, meta-analysis of weight gain in g/d based on two studies showed no evidence of difference (WMD 2.09 g/d, 95% CI -1.46, 5.64). Length gain, based on five studies, showed a non-significant WMD of 0.14 cm/wk (95% CI -0.04, 0.31). Head circumference gain, based on data from five studies, showed a non-significant WMD -0.03 cm/wk (95% CI -0.15, 0.08). Only one study reported skin fold thickness gain, with a mean difference -0.15 mm/wk (95% CI -0.41, 0.11), again not significant. Subgroup analyses according to % MCT in the high MCT formula, by 10% intervals, showed no evidence of effect of high MCT on short term weight gain within any subgroup. There are conflicting data (two studies) as to formula tolerance. There is no evidence of effect on incidence of necrotizing enterocolitis (NEC), based on small numbers in two trials. No studies were located addressing long term growth parameters or neurodevelopmental outcomes. There is no evidence of difference between MCT and LCT on short term growth, gastrointestinal intolerance, or necrotizing enterocolitis. Therefore, neither formula type could be concluded to improve short term growth or have less adverse effects. Further studies are necessary because the results from the included eight studies are imprecise due to small numbers and do not address important long term outcomes. Additional research should aim to clarify effects on formula tolerance and on long term growth and neurodevelopmental outcomes, and include larger study populations to better evaluate effect on NEC incidence.

Medium chain triglycerides activate distal but not proximal gut hormones

Background and aims:Compared to long chain triglycerides (LCT), medium chain triglycerides(MCT) are considered an attractive caloric source in malabsorptive diseases because of their favorable physico-chemical characteristics. The use of MCT is, however, limited by the occurrence of gastrointestinal symptoms such as diarrhoea. We have, therefore, investigated the effects of MCT and LCT on proximal (cholecystokinin; CCK) and distal (peptide YY; PYY) gut hormone secretion. Methods:Eight healthy volunteers participated in four experiments performed in random order duringcontinuous intraduodenal administration for 360 min of a) saline (control); b) LCT 15 mmol/h; c) MCT 15 mmol/h (equimolar); d) MCT 30 mmol/h (equicaloric). Plasma CCK and PYY were determined at regular intervals (radioimmunoassay). Duodenocecal transit (DCTT) was measured by lactulose H2 breath test. Results:DCTT during LCT (105 ± 11 min) was not significantly different from saline (111 ± 10 min). Both low dose MCT (54 ± 5 min) and high dose MCT (61 ± 6 min) significantly accelerated DCTT (P < 0.05). Plasma CCK increased significantly (P < 0.05) during LCT but not during MCT or saline. PYY increased significantly (P < 0.05) not only during LCT, but also during low and high dose MCT but not during saline. Conclusions:Intraduodenal MCTs a) accelerate intestinal transit; b) do not stimulate CCK release; c) butstimulate release of the distal gut hormone PYY. These results suggest that MCTs are not rapidly absorbed in the proximal gut but probably reach the ileocolonic region and stimulate PYY release.

A CASE OF CROHN'S DISEASE SUCCESSFULLY MANAGED BY A LONG-TERM ENTERAL NUTRITION OF DIGESTED DIET CONTAINING MCT

Crohn's disease is treated by medication, operation, and alimentary therapy, and among of them the usefulness of enteral nutrition has been pointed out. Not only elemental diet (ED) but also low residue diets have been reported to be useful, however, there are few cases of long-term use of such digested diets. We have successfully managed a postoperative patient with Crohn's disease involving the small intestine and colon by enteral nutrition mainly with digested diets which are rich in lipids, especially medium-chain triglyceride (MCT) at home. The enteral nutrition was started in a remission period after operation for peritonitis due to perforation of the ileum. About three years have elapsed up to now, and normalization and maintenance of inflammatory reaction, disappearance of the subjective symptoms, maintenance of good nutritional status and weight gain were observed. The patient has recovered normal social activities without any recurrence. Low molecular peptides and MCT in the digested diet are excellent in the digestion and absorption in the body. It is thought that this digested diet regimen involving such peptides and MCT might contribute to the good nutritional management in this case.

Energy balance in low birth weight infants fed formula of high or low medium-chain triglyceride content

We tested the effect on energy balance of the partial substitution of medium-chain for long-chain triglycerides in the diet of growing low birth weight infants. Fifteen infants were studied in a randomized double-blind crossover clinical trial in which each infant was fed each of two formulas, which were of equal gross energy and protein content but differed in fat composition. The high medium-chain triglyceride (MCT) formula contained medium- and long-chain triglycerides in a weight/weight ratio of 46:54; in the low MCT formula the ratio was 4:96. The hypothesis tested was that under conditions of equal gross energy intake the two diets would differ in their digestible and metabolizable energy contents and would produce differences in the infants' rates of energy expenditure and energy storage. Gross energy intakes averaged 562 and 555 kJ/kg/day (134 and 133 kcal/kg/day) with the high and low MCT formulas, respectively. With each diet, coefficients of energy digestibility (0.93) and metabolizability (0.91) were identical; the rates of energy expenditure were 262 (high MCT) and 265 (low MCT) kJ/kg/day (63 kcal/kg/day for both diets), and of energy storage were 246 (high MCT) and 239 (low MCT) kJ/kg/day (59 and 57 kcal/day). These differences were not significant. There were also no significant differences between the two diets in coefficients of nitrogen retention (mean 0.70) or in rate of weight gain (mean 21.5 gm/kg/day). The use of high MCT content in infant formula neither provided a nutritional advantage in energy digestibility or metabolizability nor resulted in an increased rate of energy expenditure or of energy storage.