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Effects of MCT and LCT emulsions on lipoproteins pattern in infants during prolonged total parenteral nutrition (TPN)
0.71
DIFFERENT FAT EMULSIONS IN POSTOPERATIVE TPN. !!.-W.Jauch,B.Gi.inther,S.Hailer,G.Wolfram Department of Surgery,Ludwig-Maximilians-University,Munich,FRG The aim of the study was the evaluation of differences between LCT and MCT/LCT emulsions elimination and side effects on liver enzymes in nitrogen sparing effect,utiI~zation during postoperative TPN after colorectai surgery. 24 patients were randomized and received a isonitrogenous aad iosocaloric TPN with non-R protein calories as glucosekgroup G)or 50% as IntralipidIO% (L 10)or Lipofundin MCT 10% (MIO) or Lipofundin MCT20% (M20).Preoperative and on the I .,4.,and 7.postop,day liver enzymes,lipoproteins,glycerids(TG),free fatty acids(FFA),glycerol(Gly)and functional proteins were dete~ined before lipid infusion and after 12 hour lipid infusion.Also the
elimination of TG,FFA and Gly was measured after gen excretion.
12 hours lipid
infusion
and daily
nitro-
Functional proteins like prealbumin,cholinesterase showed no difference as did the nitrogen excretion .The liver enzymes were rising in the G and LIO group significantly more pronounced during the 7 day TPN(GFT day7-preop.;u/l; G-2Q,LlO-22,MlO-9,M20-2). The TG increase during lipid infusion was higher in M20 than in MI0 and LlO,because the higher molar infusion of MCT and the lower hydrolysis in M20 compared to MlO(TG increase du.ring infusion on day 4;mmol/l;LIO-0,84 ;MlO-0,81 ;M20-1,26).As parameter of TG hydolysis FFA and Gly showed a significant greater increase in M20 and MIO(Gly increase on day 4 ;mmol/l ; LIO-0,18 ;MlO-0,46 ;M20-0,28). At the end of lipid infusion elimination of FFA and glycerol showed a comparabie value in all groups and on all days with 50-70% in one hour.In contrast to this fast removal TG elimination was much lower in MI0 than in M20 or LlO(Remova1 in % on day 7 ;LIO-36%; MIO-7%; M20-44%).Correspondingly the preinfusion TG concentrations on day 7 were highest in MlO(Tg day 7;mmol/l; LIO-1,06+0,20 ; MlO-1,59+0,15 ; MZO-1,14+0,18). In LIO and Ml0 the changes in Iipoprotein composition were much more pronounced than in M20,as the emulsions had a higher phosphatid concentration. Considering utilization,elimination,liver damage and lipoproteins
fect the 20% MCT/LCT emulsion seems to be preferable to MI0 and
0.72
as well as protein efLIO or glucose alone.
EFFECTS OF MCT AND LCT EMULSIONS ON LIPOPROTEINS PATTERN IN INFANTS DURING PROLONGED TOTAL PARENTERAL NUTRITION (TPN). E. MARINIER, P. BRUN, A. GIRARD, J.P. CEZARD, J. NAVARRO. H6p. Bretonneau, INSERM U 286. To evaluate the benefit and the tolerance of MCT and LCT emulsions on lipid metabolism, children on cyclic TPN were randomized to receive lipofundin R MCT 20% (A) or Intra lipid R 20% (B) during 3 weeks (dose 2 g/Kg/24h). The infusion rate was 2.8 mg/kg/mn over 12 hours. Blood samples were collected at Day 1 and Day 21, prior to the start (HO) and 4 hours (Hl6) after the end of the infusion, after a one week "wash out" period during which children received only an isocaloric amino glucidic TPN. Total cholesterol (TC), triglycerides (TG), phospholipids (PL), LDL and HDL cholesterol (LDL c, HDL c), apolipoproteins Al and B were measured. Preliminary results on 12 children aged 1.75 to 29 months were as follows (Mean z SEM). Dl D21 D27 Normal adult HO HO H16 HO H16 (g/l) A + 0.1 0.8 0.8 + 0.1 0.6 + 0.1 0.7 + 0.1 0.7 + 0.1 0.3 - 1.5 B TG : 0.2 0.8 T 0.2 : 0.2 0.8 0.5 T 0.1 T 0.1 0.5 0.6 LDLc
0.7
-
1.8
A B
0.5 1.0
+ 0.2 : _ 0.2
0.7 + 0.1 1.0 : 0.1
0.8 0.9
* 0.2 _; 0.2
0.9 0.8
+ 0.2 ; 0.1
0.9 0.5
+ 0.2 : _ 0.3
HDLc
0.3
- 0.7
A B
0.2 0.2
+ 0.02 : 0.03
0.2 + 0.02 0.2 : 0.03
0.2 0.2
+ 0.01 : 0.02
0.2 0.1
* 0.03 ; 0.02
0.2 0.2
+ 0.01 ; 0.03
B/Al
0.2 - 0.9
;
0.53 + 0.05 0.54 Z 0.05
0.62+ 0.02
0.47 0.68
+ 0.05 ; 0.07
0.49 0.64
+ 0.07 ; 0.03
0.49 0.63
+ 0.07 ; 0.09
0.52;
0.06
All the measured parameters remained constant through the study within each group and no significant differences were observed between the 2 groups. The TG clearance was total 4 hours after the end of the infusion. No accumulation of TG rich particules was observed. In conclusion, under our experimental conditions, both emulsions did not alter the lipids parameters, and no adverse effects had been observed so far. 44
DIFFERENT FAT EMULSIONS IN POSTOPERATIVE TPN. !!.-W.Jauch,B.Gi.inther,S.Hailer,G.Wolfram Department of Surgery,Ludwig-Maximilians-University,Munich,FRG The aim of the study was the evaluation of differences between LCT and MCT/LCT emulsions elimination and side effects on liver enzymes in nitrogen sparing effect,utiI~zation during postoperative TPN after colorectai surgery. 24 patients were randomized and received a isonitrogenous aad iosocaloric TPN with non-R protein calories as glucosekgroup G)or 50% as IntralipidIO% (L 10)or Lipofundin MCT 10% (MIO) or Lipofundin MCT20% (M20).Preoperative and on the I .,4.,and 7.postop,day liver enzymes,lipoproteins,glycerids(TG),free fatty acids(FFA),glycerol(Gly)and functional proteins were dete~ined before lipid infusion and after 12 hour lipid infusion.Also the
elimination of TG,FFA and Gly was measured after gen excretion.
12 hours lipid
infusion
and daily
nitro-
Functional proteins like prealbumin,cholinesterase showed no difference as did the nitrogen excretion .The liver enzymes were rising in the G and LIO group significantly more pronounced during the 7 day TPN(GFT day7-preop.;u/l; G-2Q,LlO-22,MlO-9,M20-2). The TG increase during lipid infusion was higher in M20 than in MI0 and LlO,because the higher molar infusion of MCT and the lower hydrolysis in M20 compared to MlO(TG increase du.ring infusion on day 4;mmol/l;LIO-0,84 ;MlO-0,81 ;M20-1,26).As parameter of TG hydolysis FFA and Gly showed a significant greater increase in M20 and MIO(Gly increase on day 4 ;mmol/l ; LIO-0,18 ;MlO-0,46 ;M20-0,28). At the end of lipid infusion elimination of FFA and glycerol showed a comparabie value in all groups and on all days with 50-70% in one hour.In contrast to this fast removal TG elimination was much lower in MI0 than in M20 or LlO(Remova1 in % on day 7 ;LIO-36%; MIO-7%; M20-44%).Correspondingly the preinfusion TG concentrations on day 7 were highest in MlO(Tg day 7;mmol/l; LIO-1,06+0,20 ; MlO-1,59+0,15 ; MZO-1,14+0,18). In LIO and Ml0 the changes in Iipoprotein composition were much more pronounced than in M20,as the emulsions had a higher phosphatid concentration. Considering utilization,elimination,liver damage and lipoproteins
fect the 20% MCT/LCT emulsion seems to be preferable to MI0 and
0.72
as well as protein efLIO or glucose alone.
EFFECTS OF MCT AND LCT EMULSIONS ON LIPOPROTEINS PATTERN IN INFANTS DURING PROLONGED TOTAL PARENTERAL NUTRITION (TPN). E. MARINIER, P. BRUN, A. GIRARD, J.P. CEZARD, J. NAVARRO. H6p. Bretonneau, INSERM U 286. To evaluate the benefit and the tolerance of MCT and LCT emulsions on lipid metabolism, children on cyclic TPN were randomized to receive lipofundin R MCT 20% (A) or Intra lipid R 20% (B) during 3 weeks (dose 2 g/Kg/24h). The infusion rate was 2.8 mg/kg/mn over 12 hours. Blood samples were collected at Day 1 and Day 21, prior to the start (HO) and 4 hours (Hl6) after the end of the infusion, after a one week "wash out" period during which children received only an isocaloric amino glucidic TPN. Total cholesterol (TC), triglycerides (TG), phospholipids (PL), LDL and HDL cholesterol (LDL c, HDL c), apolipoproteins Al and B were measured. Preliminary results on 12 children aged 1.75 to 29 months were as follows (Mean z SEM). Dl D21 D27 Normal adult HO HO H16 HO H16 (g/l) A + 0.1 0.8 0.8 + 0.1 0.6 + 0.1 0.7 + 0.1 0.7 + 0.1 0.3 - 1.5 B TG : 0.2 0.8 T 0.2 : 0.2 0.8 0.5 T 0.1 T 0.1 0.5 0.6 LDLc
0.7
-
1.8
A B
0.5 1.0
+ 0.2 : _ 0.2
0.7 + 0.1 1.0 : 0.1
0.8 0.9
* 0.2 _; 0.2
0.9 0.8
+ 0.2 ; 0.1
0.9 0.5
+ 0.2 : _ 0.3
HDLc
0.3
- 0.7
A B
0.2 0.2
+ 0.02 : 0.03
0.2 + 0.02 0.2 : 0.03
0.2 0.2
+ 0.01 : 0.02
0.2 0.1
* 0.03 ; 0.02
0.2 0.2
+ 0.01 ; 0.03
B/Al
0.2 - 0.9
;
0.53 + 0.05 0.54 Z 0.05
0.62+ 0.02
0.47 0.68
+ 0.05 ; 0.07
0.49 0.64
+ 0.07 ; 0.03
0.49 0.63
+ 0.07 ; 0.09
0.52;
0.06
All the measured parameters remained constant through the study within each group and no significant differences were observed between the 2 groups. The TG clearance was total 4 hours after the end of the infusion. No accumulation of TG rich particules was observed. In conclusion, under our experimental conditions, both emulsions did not alter the lipids parameters, and no adverse effects had been observed so far. 44