Metabolic Clearance of a Fat Emulsion Containing Medium‐Chain Triglycerides in Cirrhotic Patients

Abstract

Medium-chain triglycerides (MCTs) may be advantageous in cirrhotic patients, but data on the clearing capacity are lacking. Intravenous fat tolerance test (IVFTT) was performed on 28 cirrhotic patients (Child's A, n = 9; Child's B, n = 13; Child's C, n = 6) to determine the clearance rate of Lipofundin MCT 20%, which contains a physical mixture of MCT and long-chain triglycerides (LCT). The mean fractional elimination rate (k2) of MCT/LCT physical blend in the cirrhotic patients (7.72%/min) was comparable with that of the healthy control subjects (n = 9, k2 = 5.43%/min). Significantly higher serum free fatty acid (FFA) levels were found in the cirrhotic patients during IVFTT. The difference could be accounted for by their higher basal levels. In all patients, serum FFA concentrations returned to basal value at the end of 1 hour. Prompt appearance of glycerol and beta-hydroxybutyrate was seen during IVFTT, indicating that hydrolysis of triglycerides and release of ketone bodies from the liver were rapid. It was concluded that the ability to eliminate MCT/LCT physical blend was not impaired in the cirrhotic patients.

Preservation of nutritional‐status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis

“…Medium‐chain triglycerides, which have a reduced dependence on albumin and apoprotein C‐II for breakdown 47 and on carnitine for intracellular metabolism, 48 were therefore included. An additional advantage of medium‐chain triglycerides is that they are readily oxidized by all body tissues, and little is deposited in the liver 48,49 . There are no reports of post‐paracentesis nutritional‐support for patients with cirrhotic RA undergoing repeated large‐volume paracentesis.…”

A study of the ameliorating effects of carnitine on hepatic steatosis induced by total parenteral nutrition in rats

“…It is commonly thought that LCT predisposes to liver function damage. But, Fan et al [8] reported that the MCT/LCT clearance rate was not impaired in cirrhotic livers, and hence believed that MCT/LCT was suitable for TPN in patients with liver cirrhosis. Our study showed that TPN using MCT/L CT could lead to hepatic steatosis in both normal rats (group B1) and cirrhotic rats (group B2).…”

REVIEW: Nutritional support for patients with cirrhosis

“…Instead, data of clearance of a physical mixture of M C T and LCT in cirrhotic patients indicates that clearance of the M C T L C T mixture is not impaired, but there is a tendency towards accumulation of fatty acid and glycerol in the serum, which is proportional to the severity of the liver disease. 37 The data support the use of an MCTLCT mixture in the form of intermittent infusion because the accumulated fatty acid and glycerol can be cleared in the intervening period. Pure M C T is not available commercially and, in practice, concomitant LCT infusion is needed to provide a component of the cell membrane essential for hepatic regenerati~n.~~ The dose of lipid emulsion should be limited to 1 g/kg per day.…”