‘I’m :
Au
:mnmesx
%ui.
JonTmiNAm,
21,
Nu.
I’r,nted
1965, in
N m’inm-rmox
(‘mixicim,
OF’
4, April, (
pp
30W-itO
.1.
‘...
Absorption
of Dietary
Medium-Chain
Fat:
Use
of
Triglycerides
in Malabsorption1’2’ ROBERT
BOUT
98%
of
man Most
can
(i).
acids
prottumcts
1-1-18
anti
amotr (MCT)
atonss.
Tisere
are
sssarked
of
rarionsal
in
disomtlens.
Figunre
1
LCT,
sifieth
by
bile
lyzed
by
panscreatic
nions
into
isyclrolysis and glycerol
by only
form
variety of
munst
nusicrons
ins
(3).
to tise
Chyhonuicron
addition 1
to
I)epartmnsenst
Medicinse, 2 Supported
AM
(ransts ‘Ihse
gratefully
rise
03966,
be
liver
requnires, and
liv
Haveni, Nationnal
Comsnsecticut. Institutes
FR 00123, assistansce
of
amid Miss
University
may
rise
are
also
acids,
e.g.,
chain
fatty
Health
far
acids,
incorporated octanoate
Gillette
no CO2
acknsowledged.
300
is (11).
much As
of
MCT
differences
in
fatty
more slsowms
to
palmitate.
nissume
palmirane
lipid.
In
Fig.
long-
In
than readily in
an
Parenthet-
compared
e.g.,
the
as
medium-chsails
octanoane into
hipase
(10).
nusarked
ocranoane,
oc-
via or
(9).
or
rise
liver
salt
colon
of
less
a
complex rise
metabolism
liver,
FR 38-06. Barbara
in
Thuere
in small
of
rise
oc-
acetate
absorption
occur
rise
mucosal
no as
8-12
of
most
nise
iusono-
with
to
(8),
appreciable also
for acids
canabolized by
be-
monoglycenide
some
directly
is
probably
fanny
acitl
activity
monoglycenide
activity
either
the
MCT.
little
reaction,
Although
vein,
in intestinal
Isydrolyzes
Little
released
to hipase
present
exisibins
dioxitie
are
appear
rise
mucosal
nransporretl
ically,
School of
carbon
much
pancreatic
is
nsaxinsal
albumin-fanny
rise
is lipase
of
this
be
rriocprior
pancreatic MCT
containing
nanoate
nissuies
fornssanion
\‘ahe
hsas
is
no cisylo-
niiglycenicles Medicimie,
intestinal
lipase
portal
via
nsanumucosa
absorption
hipase
(7).
from
ca use
to
reac-
other
protein,
MCT, e.g., wirisour
actively
LCT
may
are
A
lipase
tanoane
exporred and
intestinal
for
which
Following
into
Indeed,
inucosal
atoms.
shown,
rise
fraction
carbon
acids
5).
(6).
glycerides
reconstituted
of New
techsnsical
are
incorporated
order no
cata-
enzymatic
Tisese
be
lynspisanics
of whiicls
triglycerides.
LCT
is
a some
LCT
no absorp-
fatty
atud
substrates
recovered
undergo
mtmcosa.
long-chains
better
toward
the
issonoglycerides,
prior
salts
(4,
mucosa
emul-
being muist
to
intesninsal rise
tions,
after
hipase,
by
(3-globulin,
alnhsoungii if bile
This
in are
cholesterol of
a
to LCT, h)e ai)sorbed
microsonual use
tlsat
be
pamn,
contrast cans
nisan
of
nialabsorpnive
sisows
ansth,
be
provided
rnipalminin,
salts
absorption,
of
e.g.,
tue
esnenified
of
and coating
to
in
hiydrolysis,
the
therapeutic
variety
insnesnimse,
ins traluminal fanny acids,
have
rise
for
a
appears
better
no nhsan
differences
basis
MCT
in
conspared
MCT
Tisese
whiicls
In tanoin,
acids
differences
phosphohipids
surrounding
available
carbon
(2).
fanny
of
a
(2).
Milk
isowever, luave nssecli tnns-clsain
conrainsing
of 6-12 nsenabolisnn
atoms.
ts
esters,
facrumeti,
of
conuposed
oil, of
murs
ainouns
lipid Amen-
triglycerides are long-
carbons
coconunt
ble
triglycerides
of
dietary
average
(LCT)
wins
conusitlera
LCT
g of tlse
is in the fonmus of of nhsese triglycerides
triglycerides
fatty
a
145 by
M.D.
contrast, oxidized
2, ocranoate
the is
Downloaded from www.ajcn.org by on January 25, 2008
(‘hails
rise
daily
ingested
SCHEIG,
Absorption LUMEN
of
Dietary
301
TRIOCTANOIN
TRIPALMITIN IPanaentk
MONOALMITIN
Fat
P,cr.ohcn
Li.
PALMTTATE
LIPOH
GLYCjFIOL
OCTANOATE
I
MUCOSA
-
PALMITATE
GLYCEROL
C0A
MONOPALMITIN
TRIOCTANOIN
Giycrol
Mucosol L’poss
Kinoss
GoA
PALMITYL
L- s-GLYCEROL
PHOSPHATE
I
.TRIPALMIflN
.
OCTANOATE
‘
Chylo,nicron fousOtios
SEROSA
TRIPALMITIN CHYLOMICRONS LYMPHATICS
in
OCTANOATE ALBUMIN in PORTAL
in
FIG.
-
COMPLEX VEIN
1.
Downloaded from www.ajcn.org by on January 25, 2008
FIG.
is
also
readily
phsragm,
heart,
The
iah)id
fanny
acids
nisuis
support
tact
fats
or
in
rise
portosystenisic
in Isas
tions
of
been
is
just
calories.
numnnienns in
of
nisan
of rise
atlnsinisreretl m-apid
in
rise
m-ats
nsenr
been
as in
control
usefulness of
berweenu an(1
inrise
knuowledge
nise
musetabohic
oxida-
patscreas pan of striking
(16),
nlse
the LCT chinuuinuntion
treatcan of
be dif-
panhsway
(leficiency. (13,
(15),
rise
of LCT.
lipase
pimscreas
ins
nisis
insufficiency
blooth
whsicis
thsar
Pancreatic
creatic
MCT
rise
(12).
disomtlers
from
of
fi-om
amsimals
of
fcnences MCT
excluded
nsalabsorpnion
mssay
liver
acids.
hsas
circunlanions
anticipated
ocin
liver
fatty
This rise
presence
sisown as
may
oxidation. occur
long-chains
The
tissues
shsunning
insnravenoursly
and
iusedium-cluain
oriser issay
even
diatissune.
providing
from
protiunction
sinsce tanoate
and
spared
nisediumii-
kidney,
various by
of
adipose
of
nisese
growth
animal
disease
by and
catabolism
be
ensen-gy
Oxidation
oxitiizeti bn-ain, by
Long-cisain thuen-eby
2.
and
14), cystic
sunbstituntion in
Ins
pan-
carcinoma
of
fibrosis of
rise tliet cars in sneanorrisca.
of MCT
the for
cainsc a Chsih-
Sciseig
302
Effect
of
MCT
on
steatorrhca
cholesterol
levels bihiarv
t)aily
and
serum
in primary
Fat
g/24
Serum
hr
Length of Tine, Months
cholesteron,
mg/100
ml
patient
The
tlecrease
us
Hot
After
On
MCT
MCT
MCT
9(X)
260
12
absorbetI
it
related
was
844
248
1
h)inthing
F.V
28
13
460
192
2
ins
nakimsg
salt
acconss1)hisheti
resins
that
iunscns
1))
tise
a
i)asic
binsds
aruth
prurinuns
salts unseti
tornisea
be
abolishsed
LCT
rhie
triglycerides crease
in
anti
biliarv
girl
wins
partial
neonatal
arresia
(18,
comusbined a
as
for
arresia,
18
daily
fecal
ann increased isheth
fat rate
loss of
requniremen
control cisolesnerol vations).
The
effect
of 55
sreatorniset
data
g
MCT
and
anti
serums
biliary (18),
55
g daily,
25-g a
25
LCT
to
12
no
in
serum
mssg/100
ml obser-
i
LCT
cisolesrerol
i)t tiers ts ivi thu l)ninlar)
(23),
sisow daily)
rise
are
cm-rho-
in
Defect via
In
or
as
some
nitrogen
pa-
loss
synthesis.
anti
Impaired occur
is
fan
congenital
when
defective.
absorbed
via
chsylomicron
Be-
the
portal
formation, loss
and
the
weight
-hipopronein
gain
deficiency
(24). in
lymphatic
Becannse rise
significantly
snearorrhea
fecal
predictable
intestine.
22), and
alone
diet.
synnhsesis is
without
be
(21, (19),
occur. and
MCT
in
may
LCT
MCT
associated
niserapy
a
small rapid
of
syndrome
protein
absorpnions
seen
is
nutritional
resection
(15)
also
of more
the
fecal
in
rise
malabsorpnion
MCT
cisylomicron
on
levels bihiary
gain
diminisised
(diets
absorption
LCT,
no
Defect
vein
these loss
area
and
blind-loop
weighut
caurse
in fan
no
intestinal
decreased
fan
appreci-
LCT
abso;ptive
rise
tients, g,
a dimin-
niserapy g
and massive
sunpplemenrs
decrease
30
Table
status sprume
disease.
fecal
i-elated
wins
with
al-
concomitant
are
nhuan
hydrolysis
by
105
MCT
of
conspared de-
umnpublisised in
prolonged
rare
ennerinis
fall
to
Klarskin,
in
Probably
bowel.
improved
gain,
a
288
for
unknown
no
(20).
Reduction can
clsolesnynamine
and
from and
for
dinsinishued
with
pancreatic
thereby
regional
a
from
and
a 9-year-old
in
weigisr
n
prtmnitus,
(Schseig
no resunired
better
(AB)
albumin steanorrhea
triglycerides
innrahsepanic oil,
supplement
or
absorbetl
nsarked
In anti
MCT
months
obstruction
abhy
wins
19).
wisich related
biliary
control
is
of
one
Patients
have
be
of
patiemsts
ml.
may
were
patients
serum
may
cause it
serum
hseparinis
extra-
g/100
intestinal
MCT
associated
2.9
the
gain
adult
alnhsounghs
cirrhosis rise
weight nhuree in
no
unfor
Changes
cinrlsosis
though
Medium.ciuain a
rise
salts
increase
be
cisolesnasis.
cause
(14),
hihiany
addeth
muuay
of
n
cisolcsryranuimue (17).
srearorrisea
obstructions
severe
chsoiesnyransine.
SIethi unm-cisai
no
substitunning
then
also
also,
between
bile
of
excisange
lower
also
by
by
in
no
wins
induced
an 1.8
sne-
can
ins nise
and
associated
Snea
salts,
This anionic
is
levels
biliary
shsowed alcoholic
administration
bile
nisar
chsolcsteroi
1)ihe
i)roditntedl.
cisohestyramnine,
wins
rise
reducing
of
be
can
signifi-
frons By
concentrations
atornisea
no in-
gains
MCT.
deficiency.
innestinsal
isoneth
weighsr
is thuat
lymphsanics
of
drainage
they anti
are
non
nhsuns
small
absorbed should
non
Downloaded from www.ajcn.org by on January 25, 2008
s’hsile
Bile
were
of
boris
given
speculate
amsth anti
none
tiuis
when
nsighsn
function
in
of for
were
one acids
sites
liver
institution
to comuspeninion
fatty
seen
tlse
cisolesnerol
bunt
isad daily
muuechsanism
cholesryn-amine
kmsowni,
Before
patients
control prurinus, but in serunm cholesterol no
serum
and
7
cant!)
rim i-cc
prior
niserapy.
all
clsolesnyramine
I year to change
least occunrred
After MCT
fibrosis
of
MCT
25
cystic
g
hevels
Ri
rate
were
at
significant
16
tiseir
in
fom
48
is-iris
tisat
12
rio
.IB
crease
diet
taking
MCT Before MCT
drenu
is norewortisy
been
cirrhosis
Fecal
Loss,
It
sis.
TABLE
Absorptioms increase
lymplsatic
MCT
have
pressure
proved
ing
cisyluria,
chylonhorax,
antI
exundanive
enneropanisy
Fam
ilial thisorder,
whuicis
hipoprotein nsay
lipase
lead
serum
to
is
wounlti
ineffective
in
tim-are-induced
Side
from
Thsere
rise
rare
be
glucose
abthonsinal with to
thiarn-isea
is
occurs.
palatable
12.
a
may
13.
be 14.
1-ecipes
diets
quite
supply.
A
J.
Aiim. 2. 3.
review
ISSELBACHER,
Bn.oom,
United
trends.
of
ZVutr.
20: 907,
K. J.
Biochensiical
J.
lymph fatty
as
1909-1913
of
Vu.nmvnso,
V.
ins fluencing
the
triglyceride.
I. phase
of
IV. 0.
AND
for
differenst
fat
of
The
role
of
absorption.
influencing
the
triglyceride. thse
6.
D.,
JSSELBACHER.
48:
AND
transport
of
17.
A. D.
role
phase
336, N.
of of of
Soc.
V.
D.,
of
octamsoic
a
medium
in
18.
chains
the
Absorption
S.
Pancreatogensous
rsle(hiunn
Res.
10: 394,
E.
IBER,
H.
B.
L.,
E.
eight
tral
fan in the
RODGERS mediuni
AND and
SCHSS’ABE.
ons
Effect
of
oxidation
Proc.
rat.
ROHOLT
Soc.
Exptl.
I.
AND
triglycerides
HARDOON
and
ten
B.
VAN
treated
(abstract). M.
ANI)
carbon
Cliii.
H.
fanny
mamsagemetst
SANGREE.
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as
mien-
of steanor’n’hsea.
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of
Use
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atsd
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of
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MEnu.
use
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S. A.
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in
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mssan.
triglycerides.
Mediumnss-clsain
treatmssenst
of
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VAN
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t of
ANt)
T.
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withi
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A am. J.
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nse-
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D.
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P.
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Hepatic
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intra-
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in ab-
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AN
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on
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a
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is
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217, 1966.
26).
icronemia
303
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Dietary
LCT,
its
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diet
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most
of
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304
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cessftml
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