EFFICACY OF A MIXTURE OF MEDIUM-CHAIN TRIGLYCERIDE (75-PERCENT) AND LONG-CHAIN TRIGLYCERIDE (25-PERCENT) FAT EMULSIONS IN THE NUTRITIONAL MANAGEMENT OF MULTIPLE-TRAUMA PATIENTS

Ten severely injured patients who were admitted to the intensive care unit and who needed total parenteral nutrition (TPN) were randomly enr olled in a prospective double-blind study comparing two 20%-fat intrav enous emulsions: one (MCT-LCT) containing a physical mixture of 75% me dium-chain triglyceride (MCT) and 25% long-chain triglyceride (LCT) an d another containing 100% LCT. TPN (30 kcal . kg(-1). day(-1)) was giv en continuously as amino acids (20% of energy) and glucose (50% of ene rgy) over 7 days with the respective lipid emulsion (30% of energy) pr ovided from 0800 to 1600 each day. Plasma substrate concentrations, ni trogen balance, resting energy expenditure, substrate net oxidation ra tes, whole-body lipolysis rates, and fatty acid reesterification rates were measured or calculated. Plasma concentrations of lipid metabolit es (glycerol, triglycerides, and fatty acids) indicated rapid hydrolys is and efficient use of the MCT-LCT emulsion. Whole-body lipolysis rat e decreased by 53% in the MCT-LCT group and by 34% in the LCT group. N et fat oxidation was greater and FFA reesterification less with MCT-LC T than with LCT, indicating more efficient and rapid fuel utilization in the post-traumatic period with the MCT-LCT emulsion. In critically ill patients dependent on intravenous nutrition, an MCT-LCT mixture ma y be useful as an obligate fuel and to limit net hepatic lipogenesis.