Objective: To compare the effects of a lipid emulsion containing medium-chain triglycerides (MCT) and supplemented with atocopherol to a conventional long-chain triglyceride (LCT) emulsion. Design: Randomised double blind study. Setting: Department of Internal Medicine, Antwerp University Hospital. Subjects and interventions: Twenty-four patients with an indication for total parenteral nutrition for a minimum of 10 days were randomly assigned to two groups: group E received as lipid source MCT=LCT (50=50) suplemented with 100 mg DL-atocopherol=day and group C received LCT. Blood samples were analysed at inclusion, after 4 -6 and after 9 -11 days. Results: In group E, serum a-tocopherol doubled from 11.4 AE 6.9 at inclusion to 20.9 AE 7.9 and to 23.8 AE 8.8 mg=ml after 4 and 9 days, respectively, but did not change in group C (P ¼ 0.008). Production of thiobarbituric acid-reacting substances (TBARS) after 120 min incubation with copper decreased from 66 AE 34 at inclusion to 29 AE 25 nmol MDA=mg LDL and VLDL-cholesterol after 4 and to 42 AE 17 after 9 days (P ¼ 0.022 when compared to group C, which underwent no significant changes). Velocity of production of fluorescent products decreased in group E but not in group C (P ¼ 0.026). Conclusions: Supplementation of TPN containing MCT=LCT with 100 mg DL-a-tocopherol=day leads to a doubling in serum atocopherol and to a decrease in the susceptibility of LDL and VLDL to peroxidation in vitro.

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