Medium chain triglycerides

from Wikipedia, the free encyclopedia
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

  • Richard R. Tenore, Jenifer Heydinger: Galante. In: Handbook of Functional Lipids. CRC Press 2005, ISBN 978-0-8493-2162-7 , pp. 177-183.
  • B. Martena, M. Pfeuffer, J. Schrezenmeir: Medium-chain triglycerides. In: International Dairy Journal. Volume 16, No. 11, 2006, pp. 1374-1382. doi: 10.1016 / j.idairyj.2006.06.015 .
  • EG Neal et al .: The ketogenic diet for the treatment of childhood epilepsy, a randomized controlled trial. In: The Lancet Neurology . Volume 7, No. 6, 2008, pp. 500-506, doi : 10.1016 / S1474-4422 (08) 70092-9 .
  • Sylvia Escott Stump: Fat Malabsorption Syndromes. In: Nutrition and Diagnosis Related Care. 6th Edition, Lippincott William & Wilkins, 2008, ISBN 978-0-7817-9845-7 , p. 398.
  • Eggert Holm: Medium-chain fatty acids. In: Metabolism and nutrition in tumor diseases: analyzes and recommendations. Georg Thieme, 2007, ISBN 978-3-13-142201-9 , pp. 112-113.
  • H. Kasper: Diet for diseases of the gastrointestinal organs. In: Nutritional Medicine and Dietetics. 10th edition, Urban and Fischer, 2004, ISBN 978-3-437-42011-5 , pp. 557-565.
  • R. Meier et al .: ESPEN Guidelines on enteral nutrition: pancreas. In: Clinical Nutrition. 25, 2006, pp. 275-284, doi : 10.1016 / j.clnu.2006.01.019 .
  • M. Adler, H. Anemüller: About tolerability and effects of new MCT diet fats enriched with essential fatty acids including the results of a pilot study. In: ZÄN. Volume 38, No. 3, 1997, pp. 167-178 ( Online; PDF; 8 MB ).
  • G. Wolfram: Are MCTs the fat sensation? In: Nutrition review. December 10, 2001, p. 12.

Individual evidence

  1. ↑ Enig, Mary. "Coconut: In support of Good Health in the 21st Century" ( Memento of the original from February 27, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Asia and Pacific Coconut Community, 36th CocoTech Meeting. @1@ 2Template: Webachiv / IABot / www.apccsec.org
  2. ↑ Information from the Margarine Institute on MCT fats ( Memento from August 31, 2006 in the Internet Archive ) from July 6, 2012.
  3. ↑ a b 61 FR 3118 - FDA. Food additives permitted for direct addition to food for human consumption; Olestra. Food and Drug Administration, US Dept. Health and Human Services, Fed. Reg. 1996, 61 (20): 3118-3173, online .
  4. ↑ a b Information on the technical properties of the MCT oil from July 6, 2012.
  5. ↑ Franz v. Bruchhausen u. a. (Ed.): Hager's Handbook of Pharmaceutical Practice. 5th edition, ISBN 978-3-642-63389-8 , pp. 1059 f.
  6. ^ Jenifer A. Heydinger, Dilip K. Nakhasi: Medium Chain Triacylglycerols. In: Journal of Food Lipids. 3 (4), 1996, pp. 251-257, doi: 10.1111 / j.1745-4522.1996.tb00072.x .
  7. ↑ Information on the technical properties of the MCT oil from July 6, 2012
  8. ↑ Ordinance on dietetic foods (Diet Ordinance) (PDF; 207 kB) of July 17, 2012.
  9. ↑ a b Tosiaki Aoyama et al .: Research on the nutritional characteristics of medium chain fatty acids. In: J. Med. Invest. 54 (3-4), 2007, pp. 385-388, PMID 17878693 .
  10. ↑ HR Schoen: Chylous effusions in the chest and abdominal cavity . In: Langenbecks Archiv für Chirurgie 325 (1), 1969, pp. 118-126, doi : 10.1007 / BF01255898 .
  11. ^ GL Jensen et al .: Dietary modification of chyle composition in chylothorax . In: Gastroenterology . 97 (3), 1989, pp. 761-765, PMID 2502466 .
  12. ^ AP Desai et al .: Evidence for medium chain triglycerides in the treatment of primary intestinal lymphangiectasia. In: Eur. J. Pediatr. Surg. 19 (4), 2009, pp. 241-245, doi : 10.1055 / s-0029-1216389 .
  13. ↑ KL Klenoff-Brumberg, LG Genen: High versus low medium chain triglyceride content of formula for promoting short term growth of preterm infants. In: Cochrane Database Syst. Rev. 2003, (1): CD002777, doi : 10.1002 / 14651858.CD002777 .
  14. ↑ K. Widhalm, M. Götz: Long-term use of medium chain triglycerides in cystic fibrosis. In: Vienna Clin. Wochenschr. 88 (17), 1976, pp. 557-561, PMID 997539 .
  15. ↑ Romero F. Botella, JJ Alfaro Martínez: Nutritional repercussions and management of chronic pancreatitis. Suppl 2, 2008, pp. 59-93, PMID 18714412 .
  16. ↑ PB Jeppesen, PB Mortensen: The influence of a preserved colon on the absorption of medium chain fat in patients with small bowl resection. In: Good . 43 (4), 1998, pp. 478-483, PMID 9824573 .
  17. ^ Nancy D. Leslie et al .: Very Long-Chain Acyl-Coenzyme A Dehydrogenase Deficiency. In: Gene Reviews. 2011, PMID 20301763 , NCBI Bookshelf ID: NBK6816.
  18. ↑ MB Gillingham et al .: Optimal dietary therapy of long-chain 3-hydroxylacyl-CoA dehydrogenase deficiency. In: Mol. Genet. Metab. 79 (2), 2003, pp. 114-123, PMID 12809642 .
  19. ↑ PR Huttenlocher, AJ Wilbourn, JM Signore: medium-chain triglycerides as a therapy for intractable childhood epilepsy. In: Neurology. Hagerstown Md 21.1971, 11, pp. 1097-1103, PMID 5166216 .
  20. ^ A b E. H. Kossoff, AL Hartman: Ketogenic diet: new advances for metabolism based therapies. In: Current Opinion in Neurology . 25 (2), 2012, pp. 173-178, doi : 10.1097 / WCO.0b013e3283515e4a .
  21. ^ CS Lieber et al .: Beneficial effects versus toxicity of medium chain triacylglycerols in rats with NASH. In: J. Hepatol . 48 (2), 2008, pp. 318-326, doi : 10.1016 / j.jhep.2007.09.016 .
  22. ↑ Koji Nagao, Teruyoshi Yanagita: Medium-chain fatty acids: Functional lipids for the prevention and treatment of the metabolic syndrome. In: Pharmacological Research . 61, 2010, pp. 208-212.
  23. ^ Fritz Heepe, Maria Wigand: MCT fats . In: Lexicon Dietetic Indications: Special Nutritional Therapy and Dietetics. 4th edition, Springer, 2002, ISBN 978-3-540-42441-3 , p. 49.
  24. ↑ H. Kasper, HA Kühn: The influence of triglycerides of medium-chain fatty acids on vitamin A absorption in humans. In: Clin. Wschr. 1968, 46 (22), p. 1227, doi : 10.1007 / BF01710859 .