Effects of medium-chain and long-chain triacylglycerols in pediatric surgical patients

Medium-chain triacylglycerols (MCTs) have been shown to provide better nutr itional support than long-chain triacylglycerols (LCTs). This study compare s the efficacy of MCT combined with LCT with LCT alone in pediatric patient s with surgical stress. Two groups of patients (n = 19 in each) received eq uivalent amounts of glucose (12 g . kg . d) and amino acids (2 g . kg . d), but one group received 10% Lipofundin MCT/LCT and the other received 10% L CT (1.5 g . kg . d) in a randomized study. Total parenteral nutrition (TPN) was given for 13 d. Blood and urine samples were collected before and afte r TPN administration for determination of various biochemical parameters. I ndirect calorimetry was also performed to determine respiratory quotients a nd fuel utilization. After 14 d of TPN in the MCT/LCT group, there was a si gnificantly higher blood lymphocyte percentage, a decreasing tendency of se rum asparate aminotransferase and of total and direct bilirubin (P < 0.05). These changes were not observed in the LCT group. A significantly better n itrogen balance and a higher ketogenesis from day 3 were observed in the MC T/LCT group. The MCT/LCT group showed a more marked increased utilization o f fat than the LCT group, whereas carbohydrate oxidation was less in the MC T/LCT group than in the LCT group (P < 0.05). In children after surgery, MC T/LCT is more protein sparing and induces a better immune response when com pared with LCT-containing lipid emulsion. A TPN regimen containing MCT/LCT is likely to result in rapid oxidation of fats for energy without compromis ing the respiratory system. Nutrition 2000;16:401-406. (C)Elsevier Science Inc. 2000.