Medium chain triglycerides

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Example of a typical medium-chain triglyceride with two different fatty acid residues derived from caprylic acid (blue) and capric acid (red).

Medium chain triglycerides (MCT) ( English medium-chain triglycerides , MCT) or MCTs are triglycerides containing medium fatty acids contain. The medium-chain fatty acids include caproic (C 6: 0), caprylic (C 8: 0), capric (C 10: 0) and lauric acid (C 12: 0). These are saturated fatty acids, which are mainly found in tropical vegetable fats such as coconut oil (approx. 60%) and palm kernel oil (approx. 55%) and in butter . They are also contained to a small extent in milk fat (approx. 10%). Pure MCT oil does not occur in nature, only in mixtures with other triglycerides. Compared to conventional long chain triglycerides (LCT ), MCT fats have a slightly lower calorific value (3475 kJ / 100 g to 3852 kJ / 100 g fat) and a lower smoke point .

Extraction

MCT fats are produced industrially through the hydrolysis of coconut fat and palm kernel oil, fractionation of the medium-chain fatty acids and subsequent esterification with glycerine . A pure MCT oil is colorless to yellowish, neutral in smell and taste and of very low viscosity . It is used as vegetable oil ( neutral oil declared, oleum neutral).

The composition according to DAB.  10 is 50-80% caprylic acid C8, 25-45% capric acid C10, lauric acid max. 3% and max. 2% caproic acid.

Use and dosage forms

MCT greases have been produced industrially since 1955 and, due to their special properties, are used in a variety of ways. With the GRAS application ( generally recognized as safe petition) accepted by the Food and Drug Administration (FDA) in 1994 , they gained interest, not least in the food sector. Due to their physical characteristics, the industrially obtained MCT fats are used in the production of cosmetics (ointment, cream, bath oil) and pharmaceuticals (tablets, dragee) where they are used as a carrier, solubilizer, release agent, surface treatment agent, transport agent, lubricant and lubricant, water repellent, Film and protective formers and viscosity regulators are used. Furthermore, due to their metabolic peculiarities, they are also used in the form of dietetic foods (MCT oil and MCT margarine) and products for artificial nutrition (enteral and parenteral). According to the Diet Ordinance, these products are categorized as dietetic foods for special medical purposes (balanced diets).

Physiological properties and metabolism

Fat digestion chart

Due to their shorter fatty acid chain length, MCT fats are relatively soluble in an aqueous environment and can therefore be metabolized without bile acids . Their structure does not need to be split by pancreatic lipase (enzyme of the pancreas). They are transported directly in the blood to the liver, bypassing the lymphatic system , where they are oxidized more preferably than conventional fats and more ketone bodies are formed. The transport of medium-chain fatty acids (MCFA = medium chain fatty acids ) into the mitochondria , the place where fatty acids are oxidized, is independent of carnitine . The tolerable daily intake varies from person to person and is 50–100 g and more MCT fats. To avoid side effects such as diarrhea, cramps and headaches, a start is usually made with about 20 g of MCT fat per day. This amount can be increased gradually by 5–10 g per day. With a diet with MCT fats, it is essential to ensure a supply of fat-soluble vitamins and essential fatty acids (omega 3 and 6). Fat-soluble vitamins are adequately absorbed when using MCT fats.

Importance in dietetics

Due to their metabolic characteristics, MCT fats are a valuable component of nutritional therapy in the dietetics of various clinical pictures.

Classic fields of application

Medium-chain triglycerides were first used in clinical nutrition in the 1950s for the dietary treatment of the malabsorption syndrome , as they are easily soluble in an aqueous environment and are absorbed by the organism more quickly than conventional long-chain fats. In cases of lymphangiectasia (widening of the lymph vessels), Whipple's disease (a rare infectious disease) and chylothorax (accumulation of lymph fluid in the pleural cavity), MCT fats can help relieve the congested lymph vessels. In premature babies , medium-chain fats are used to gain weight because the digestive system is not yet fully developed.

Since MCT fats can be metabolized independently of enzymes in the pancreas and only have to be broken down by gastric lipase, their use is indicated for existing exocrine pancreatic insufficiency with pronounced steatorrhea (fatty stool), provided that enzyme supplementation does not have the desired effect. Exocrine pancreatic insufficiency occurs, for example, in chronic pancreatitis and cystic fibrosis (cystic fibrosis). The extent to which their use also makes sense in combination with pancreatic supplements should be investigated in clinical studies. Another classic field of application of MCT fats is the short bowel syndrome , in which, depending on the extent and the removed section of the intestine, digestive disorders occur, especially the edible fats. If the large intestine is preserved, medium-chain fatty acids can be sufficiently absorbed and represent a suitable alternative to conventional fats. In rare congenital metabolic diseases such as the defect in the β-oxidation of long-chain (LCHAD) and very long-chain fatty acids (VLCAD), medium-chain fatty acids are an essential source of energy. In artificial nutrition (enteral and parenteral), MCT fats are also used for various diseases, mainly of the gastrointestinal tract.

Additional fields of application

Because MCT fats are more ketogenic than conventional fats, they are also used as part of the ketogenic diet (KD) as a partial replacement for LCT fats. KD is used in drug-resistant epilepsy and in some rare hereditary metabolic diseases (pyruvate dehydrogenase deficiency, GLUT 1 defect). The nutrient ratio of the classic form of KD is i. d. Usually from 3–4 parts fat and one part carbohydrates and protein. KD with MCT fats can be seen as a promising alternative to the classic form of diet for children and adults, as the higher ketogenicity of MCT fats can shift the ratio of fat to carbohydrates and protein somewhat in favor of carbohydrates. The KD is also currently in the treatment of patients with brain tumors, Parkinson's , migraine , Alzheimer's disease and NASH (nonalcoholic steatohepatitis examined). However, further studies are required to confirm the effectiveness. Due to the metabolic properties of MCT fats and their lower energy content compared to conventional fats, MCT fats have also been and are being investigated in the area of ​​weight management and in the context of metabolic syndrome . However, the study results are weak and z. Partly contradicting. Here, too, further studies are necessary in order to be able to make clear recommendations. The use of MCT fats in nutritional therapy for various diseases must be differentiated from their use in sports nutrition, where they are known as a quick source of energy and are mainly used in endurance sports.

Contraindications and Contraindications

Medium-chain fatty acids are contraindicated if there is a risk of ketoacidosis or in the presence of medium-chain fatty acid oxidation disorders ( MCAD ). Due to their low smoke point, medium-chain fats have only limited heat resistance, which is why the relevant information and instructions from the manufacturer should be observed in order to avoid increased smoke development.

literature

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Individual evidence

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