LONG-CHAIN AND MEDIUM-CHAIN TRIGLYCERIDES DURING PARENTERAL-NUTRITIONIN CRITICALLY ILL PATIENTS

Due to their special metabolic path way, medium-chain triglycerides (M CT) have been claimed to be oxidized more extensively, compared with l ong-chain triglycerides (LCT), when administered as a parenteral nutri tional support. This enhanced lipid oxidation rate of MCT emulsions co uld be particularly disclosed in hyperglycemic and hyperinsulinemic co nditions. In an attempt to further elucidate this question, we measure d substrate oxidation rates in critically ill patients liable to exper ience such metabolic conditions, that is to say postoperative patients after esophageal resection receiving 1.5 times their measured energy expenditure (n = 12) or after liver transplantation (n = 8). These pat ients received either LCT or MCT-LCT emulsions. The metabolic measurem ents were performed simultaneously by two methods, namely indirect cal orimetry and isotopic methods based on natural abundance of nutrients. Although both groups of patients were hyperglycemic and hyperinsuline mic, the measured carbohydrate and lipid oxidation rates were not diff erent with whatever type of lipid was administered. The MCT-LCT emulsi ons did not offer clear-cut advantages over LCT emulsions in criticall y ill patients when lipid energetic fate was considered.