Fatty infiltration of the liver with cholestasis is one of the complications of total parenteral nutrition (TPN). The cause has not yet been determined. It seems probable, however, that these alterations could be prevented when a mixture of medium- and long-chain triglycerides (MCT/LCT) is used as a fat component instead of the application of long-chain emulsions (LCT) alone. To determine whether this could also be demonstrated morphologically in man, 14 patients needing TPN (25 kcal/kg BW x day, carbohydrate 45%, fat 35%, protein 20%) were examined by ultrasound in order to compare liver size and gray-scale value before and after 7 days of TPN. Seven of the patients were randomly administered a MCT/LCT emulsion as their fat intake, the other seven were exclusively given LCT. There were no changes in liver size and gray-scale value in the MCT/LCT-group, whereas both parameters showed a significant rise in the patients with LCT (size: 10.4 +/- 1.4 to 11.5 +/- 1.4 cm; gray-scale value: 9.3 +/- 1.0 to 11.6 +/- 0.7). These data suggest that TPN, administered with a mixture of MCT/LCT emulsions as fat components, could reduce the risk of hepatic dysfunction such as cholestasis and fatty infiltration of the liver.

Using the forearm technique, muscular ketone body metabolism was investigated in 12 healthy volunteers during an i.v. infusion of lipid emulsions containing long chain triglycerides (LCT) or a mixture of medium- and long chain triglycerides (MCT/LCT). During the basal period, arterial concentrations and muscular extraction of beta-hydroxybutyrate and acetoacetate were linearly correlated as expected. This relationship was abolished during the infusion of both lipid emulsions. In addition, fractional extraction rates of ketone bodies were reduced. These changes were most probably mediated by elevated levels of free fatty acids and triglycerides as well.

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