Effects of medium-chain triglyceride feeding on energy balance in adult humans

The biochemistry and physiology of long-chain dicarboxylic acid metabolism

Mitochondrial β-oxidation is the most prominent pathway for fatty acid oxidation but alternative oxidative metabolism exists. Fatty acid ω-oxidation is one of these pathways and forms dicarboxylic acids as products. These dicarboxylic acids are metabolized through peroxisomal β-oxidation representing an alternative pathway, which could potentially limit the toxic effects of fatty acid accumulation. Although dicarboxylic acid metabolism is highly active in liver and kidney, its role in physiology has not been explored in depth. In this review, we summarize the biochemical mechanism of the formation and degradation of dicarboxylic acids through ω- and β-oxidation, respectively. We will discuss the role of dicarboxylic acids in different (patho)physiological states with a particular focus on the role of the intermediates and products generated through peroxisomal β-oxidation. This review is expected to increase the understanding of dicarboxylic acid metabolism and spark future research.

Dietary D-Allulose Reduces Body Fat Accumulation in Rats with and without Medium-Chain Triacylglycerol Supplementation

d-Allulose (d-psicose) is a rare sugar, that contains no calories and exhibits 70% relative sweetness when compared with sucrose. Recently, several studies have demonstrated the anti-obesity effect of d-allulose, mediated by suppressing lipogenesis and increasing energy expenditure. Medium-chain triacylglycerols (MCTs) are lipids formed by 3 medium-chain fatty acids (MCFAs) with 6-12 carbon atoms attached to glycerol. MCTs have been expensively studied to reduce body fat accumulation in rats and humans. The anti-obesity effect of MCTs was not confirmed depending on the nutritional conditions because MCT might promote lipogenesis. In the present study, we examined the effects of simultaneous intake of diets containing low (5%) or high (13%) MCTs, with or without 5% d-allulose, on body fat accumulation in rats (Experiment 1). Furthermore, we assessed the interaction between 5% MCT and 5% d-allulose in the diet (Experiment 2). In Experiment 1, intra-abdominal adipose tissue weight was significantly greater in the high MCT diet groups than in the commercial diet (control) group. d-Allulose significantly decreased weights of intra-abdominal adipose tissue, carcass fat, and total body fat, however, these weights increased as the amount of MCT added increased. In Experiment 2, d-allulose significantly decreased almost all body fat indicators, and these values were not influenced by the presence or absence of MCT addition. The anti-obesity effect of d-allulose was observed with or without dietary MCT, and no synergistic effect was detected between d-allulose and MCT. These results suggest that d-allulose is a beneficial food ingredient in diets aimed at reducing body fat accumulation. However, further research is required on the synergistic effects between d-allulose and MCTs.

Exploring the metabolic fate of medium-chain triglycerides in healthy individuals using a stable isotope tracer

BACKGROUND & AIMS

Medium chain triglyceride (MCT) supplementation is often recommended as treatment for patients with long-chain fatty acid β-oxidation (lcFAO) disorders, since they can be utilized as an energy source without the use of the defective enzyme. However, studies in mice and preterm infants suggest that not all medium-chain fatty acids (MCFA) are oxidized and may undergo elongation to long-chain fatty acids (LCFA). In this single blinded study, we explored the metabolic fates of MCT in healthy individuals using a ¹³C-labeled MCT tracer.

METHOD

Three healthy males in rest received on two test days a primed continuous infusion of glyceryl tri[1,2,3,4-¹³C₄]-octanoate with either an isocaloric supplementation of 1) exclusively MCT (MCT-only) or 2) a mixture of MCT, proteins and carbohydrates (MCT-mix). Gas chromatography - combustion - isotope ratio mass spectrometry (GC-C-IRMS) was used to determine ¹³C-enrichment of long-chain fatty acids in plasma and of ¹³CO₂ in exhaled air.

RESULTS

When provided as single energy source, an estimated 42% of administered MCT was converted to CO₂. In combination with carbohydrates and proteins in the diet, oxidation of MCT was higher (62%). In both diets <1% of ¹³C-label was incorporated in LCFA in plasma, indicating that administered MCT underwent chain-elongation to LCT.

CONCLUSIONS

Although the relative MCT oxidation rate was higher when combined with carbohydrates and protein, quantitatively more MCT was oxidized when given an isocaloric meal with solely MCT. As these results were obtained in the resting state opposed to during exercise, it is too early to give a recommendation concerning the use of MCT in lcFAO disorders. The data show that in resting healthy individuals only a very small part of the MCT is traced back as LCFA in plasma, suggesting that MCT treatment does not result in a large LCFA burden, however further research on storage of MCT in tissues is warranted.

REGISTRATION

The study was registered in the Nederlands Trialregister. Protocol ID: Trial NL7417 (NTR7650).

Treatment with medium chain fatty acids milk of CD36-deficient preschool children

OBJECTIVE

CD36 deficiency is characterized by limited cellular long chain fatty acid uptake in the skeletal and cardiac muscles and often causes energy crisis in these muscles. However, suitable treatment for CD36 deficiency remains to be established. The aim of this study was to evaluate the clinical and metabolic effects of medium chain triacylglycerols (MCTs) in two CD36-deficient preschool children who often developed fasting hypoglycemia and exercise-induced myalgia.

METHODS

Fasting blood glucose, total ketone bodies, and free fatty acids were examined and compared for usual supper diets and for diets with replacement of one component with 2 g/kg of 9% MCT-containing milk (MCT milk). Changes in serum creatine kinase and alanine aminotransferase levels, resulting from replacement of glucose water intake with 1 g/kg of MCT milk and determined by using bicycle pedaling tasks, were examined and compared. Hypoglycemic and/or myalgia episodes in daily life were also investigated.

RESULTS

Biochemically, participants' blood glucose and total ketone bodies levels after overnight fasting substantially increased after dietary suppers containing MCT milk. Increases in serum creatine kinase and alanine aminotransferase levels resulting from the bicycle pedaling task were suppressed by MCT milk. Hypoglycemia leading to unconsciousness and tachycardia before breakfast decreased after introduction of dietary suppers containing MCT milk. Occurrence of myalgia in the lower limbs also decreased after intakes of MCT milk before long and/or strenuous exercising.

CONCLUSION

Our results suggest that MCTs can prevent fasting hypoglycemia and exercise-induced myalgia in CD36-deficient young children.

Ingestion of medium chain fatty acids by lactating dairy cows increases concentrations of plasma ghrelin

The purpose of this study was to elucidate the effects of medium-chain fatty acids (MCFAs) on plasma ghrelin concentration in lactating dairy cows. Five early-lactating Holstein cows were randomly assigned to 2 dietary treatments in a crossover design with 2-wk periods. Treatments consisted of diets supplemented or not (control) with calcium salts of MCFAs (MCFA-Ca; 1.5% dry matter). Plasma hormone and metabolite concentrations in blood samples taken from the jugular vein were measured on the morning of feeding on day 14 of each period. Dry matter intake, milk protein, and lactose content of cows fed the MCFA-Ca diet were decreased compared with controls, but with no change in milk yield. Plasma ghrelin concentrations were higher in cows fed the MCFA-Ca diet; however, no significant effect was found on glucagon-like peptide-1 concentrations in plasma. Plasma insulin concentrations decreased, but plasma glucagon concentrations remained unchanged in cows fed the MCFA-Ca diet. The concentrations of nonesterified FAs, total cholesterol, and β-hydroxybutyrate in plasma increased in these cows. In conclusion, dietary MCFAs increase the plasma ghrelin concentrations in lactating dairy cows.

Hypoxia-inducible factor stabilizers and other small-molecule erythropoiesis-stimulating agents in current and preventive doping analysis

Increasing the blood's capacity for oxygen transport by erythropoiesis-stimulating agents (ESAs) constitutes a prohibited procedure of performance enhancement according to the World Anti-Doping Agency (WADA). The advent of orally bio-available small-molecule ESAs such as hypoxia-inducible factor (HIF) stabilizers in the development of novel anti-anaemia therapies expands the list of potential ESA doping techniques. Here, the erythropoiesis-stimulating properties and doping relevance of experimental HIF-stabilizers, such as cobaltous chloride, 3,4-dihydroxybenzoic acid or GSK360A, amongst others, are discussed. The stage of clinical trials is reviewed for the anti-anaemia drug candidates FG-2216, FG-4592, GSK1278863, AKB-6548, and BAY85-3934. Currently available methods and strategies for the determination of selected HIF stabilizers in sports drug testing are based on liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS). For the support of further analytical assay development, patents claiming distinct compounds for the use in HIF-mediated therapies are evaluated and exemplary molecular structures of HIF stabilizers presented. Moreover, data concerning the erythropoiesis-enhancing effects of the GATA inhibitors K7174 and K11706 as well as the lipidic small-molecule ESA PBI-1402 are elucidated the context of doping analysis.

Enhancement of muscle mitochondrial oxidative capacity and alterations in insulin action are lipid species dependent: potent tissue-specific effects of medium-chain fatty acids

OBJECTIVE

Medium-chain fatty acids (MCFAs) have been reported to be less obesogenic than long-chain fatty acids (LCFAs); however, relatively little is known regarding their effect on insulin action. Here, we examined the tissue-specific effects of MCFAs on lipid metabolism and insulin action.

RESEARCH DESIGN AND METHODS

C57BL6/J mice and Wistar rats were fed either a low-fat control diet or high-fat diets rich in MCFAs or LCFAs for 4-5 weeks, and markers of mitochondrial oxidative capacity, lipid levels, and insulin action were measured.

RESULTS

Mice fed the MCFA diet displayed reduced adiposity and better glucose tolerance than LCFA-fed animals. In skeletal muscle, triglyceride levels were increased by the LCFA diet (77%, P < 0.01) but remained at low-fat diet control levels in the MCFA-fed animals. The LCFA diet increased (20-50%, P < 0.05) markers of mitochondrial metabolism in muscle compared with low-fat diet-fed controls; however; the increase in oxidative capacity was substantially greater in MCFA-fed animals (50-140% versus low-fat-fed controls, P < 0.01). The MCFA diet induced a greater accumulation of liver triglycerides than the LCFA diet, likely due to an upregulation of several lipogenic enzymes. In rats, isocaloric feeding of MCFA or LCFA high-fat diets induced hepatic insulin resistance to a similar degree; however, insulin action was preserved at the level of low-fat diet-fed controls in muscle and adipose from MCFA-fed animals.

CONCLUSIONS

MCFAs reduce adiposity and preserve insulin action in muscle and adipose, despite inducing steatosis and insulin resistance in the liver. Dietary supplementation with MCFAs may therefore be beneficial for preventing obesity and peripheral insulin resistance.

Influence of ketone body and the inhibition of fatty acid oxidation on the food intake of the chick

1. Fatty acid oxidation is known to be involved in the control of food intake in mammals. The effect of fatty acid oxidation on food intake in chickens was studied using a ketone body (beta-hydroxybutyrate (beta-HB)) and mercaptoacetate (MA) (an inhibitor of fatty acid oxidation). 2. Central and peripheral injection of beta-HB decreased food intake in a dose-dependent manner, while low doses of MA had no effect. Higher doses of MA inhibited feeding but also caused mortality. 3. These results indicate that ketone bodies act as an inhibitory signal for food intake in both the central and peripheral nervous systems but that inhibition of fatty acid oxidation may not be associated with feeding behaviour in chicks.

Medium chain fatty acid metabolism and energy expenditure: obesity treatment implications

Fatty acids undergo different metabolic fates depending on their chain length and degree of saturation. The purpose of this review is to examine the metabolic handling of medium chain fatty acids (MCFA) with specific reference to intermediary metabolism and postprandial and total energy expenditure. The metabolic discrimination between varying fatty acids begins in the GI tract, with MCFA being absorbed more efficiently than long chain fatty acids (LFCA). Subsequently, MCFA are transported in the portal blood directly to the liver, unlike LCFA which are incorporated into chylomicrons and transported through lymph. These structure based differences continue through the processes of fat utilization; MCFA enter the mitochondria independently of the carnitine transport system and undergo preferential oxidation. Variations in ketogenic and lipogenic capacity also exist. Such metabolic discrimination is supported by data in animals and humans showing increases in postprandial energy expenditure after short term feeding with MCFA. In long term MCFA feeding in animals, weight accretion has been attenuated. These differences in metabolic handling of MCFA versus LCFA are considered with the conclusion that MCFA hold potential as weight loss agents.

Effect of ketone bodies on crop emptying in the chicken

1. The effect of ketone bodies on crop emptying was studied in chickens in 2 experiments. In the first, the effect of beta-hydroxybutyrate, acetoacetate or acetone on relative crop content was measured. The effects of dietary medium and long chain triacylglycerols upon serum beta-hydroxybutyrate were investigated in the second. 2. beta-Hydroxybutyrate, but not acetoacetate and acetone, delayed crop emptying in a dose dependent fashion. Serum beta-hydroxybutyrate concentration was high in chicks given medium chain triacylglycerol, when compared with long chain triacylglycerol. 3. The results suggest that delayed crop emptying induced by medium chain triacylglycerol could partly be explained by an enhanced concentration of serum beta-hydroxybutyrate, which is the result of the rapid oxidation of medium chain fatty acids.

Distinction of dicarboxylic aciduria due to medium-chain triglyceride feeding from that due to abnormal fatty acid oxidation and fasting in children

Increased amounts of dicarboxylic acids are excreted in human urine under conditions of medium-chain triglyceride (MCT) feeding, abnormal fatty acid oxidation (FAO) and fasting. Criteria to distinguish dicarboxylic aciduria originating from MCT feeding and other conditions are needed in urinary organic acid profiling for detecting inborn errors of metabolism. Patterns of dicarboxylic aciduria in children under various conditions were compared. The relative amounts of medium-chain saturated dicarboxylic acids in urine are not reliable for identifying MCT-induced dicarboxylic aciduria. On the other hand, low ratios of unsaturated to saturated dicarboxylic acids (<0.1) and 3- hydroxydecenedioic to 3-hydroxydecanedioic acids were found to be useful in identifying dicarboxylic aciduria due to MCT ingestion. Additional unique features of dicarboxylic aciduria from MCT are low ratios of 3-hydroxydodecanedioic to 3-hydroxydecanedioic acid (<0.14) and 3-hydroxyadipic to adipic acid (<0.02).

The accumulation and energy load of exogenous lipids in cirrhotic rat liver after partial hepatectomy

BACKGROUND

The suitability of three energy substrates, glucose, medium-chain triglycerides (MCT) and long-chain triglycerides (LCT), was studied in cirrhotic rats after a partial hepatectomy.

METHODS

Rats with thioacetamide-induced cirrhosis underwent a 70% hepatectomy, and were divided into three groups. Each group was then injected with 14C-labeled glucose, 14C-labeled MCT or 14C-labeled LCT, respectively. The subsequent tissue distribution of 14C and the cumulative amount of expired 14CO2 were determined. In a second experiment, the 70%-hepatectomized cirrhotic rats received total parenteral nutrition (TPN). The source of the nonprotein calories was 100% glucose (glucose group), 60% MCT + 40% glucose (MCT group), and 60% LCT + 40% glucose (LCT group). The adenylate energy charge and the glycogen content in the liver remnant were determined.

RESULTS

The tissue distribution of 14C revealed that the fat emulsions accumulated preferentially in the liver. One hour after the partial hepatectomy, the concentration of 14C-labeled MCT in the liver remnants was threefold higher than in sham-operated controls. Similarly, the concentration of 14C-labeled LCT was twofold higher. The adenylate energy charge in the glucose group with TPN recovered to preoperative levels within 1-hour after the partial hepatectomy, whereas the LCT group with TPN showed a 24-hour delay in their recovery. The MCT group with TPN exhibited an intermediate time course.

CONCLUSIONS

It is suggested that the specific accumulation of MCT and especially LCT emulsions in the cirrhotic liver remnant acts as an energy load rather than an energy substrate.

Promotion of hepatic lipid oxidation and gluconeogenesis as a strategy for appetite control

There is considerable evidence that hepatic vagal afferents monitor the availability of liver glycogen and glucose metabolites, and that this mechanism participates in appetite regulation. Thus, promotion of gluconeogenesis and liver glycogen storage may enhance satiety. Hepatic lipid oxidation drives gluconeogenesis by positive allosteric modulation of pyruvate carboxylase and fructodiphosphatase. The rate-limiting enzyme for hepatic lipid oxidation, carnitine acyltransferase I, is activated by exogenous carnitine, and inhibited by malonyl coA. The lipogenesis inhibitor (-)-hydroxycitrate--a natural fruit acid found in the Brindall berry--can decrease production of malonyl coA in hepatocytes by potent inhibition of citrate lyase; many studies demonstrate that (-)-hydroxycitrate can reduce body fat accumulation in growing rats, owing in large part to a reduction in appetite. Joint administration of (-)-hydroxycitrate and carnitine should therefore promote hepatic lipid oxidation, gluconeogenesis, and satiety. Thermogenic effects as well as a reduction of the respiratory quotient can also be predicted. If this technique proves clinically useful in weight management, it could be used in conjunction with chromium picolinate and soluble fiber supplements, which appear to aid hunger control at the level of the hypothalamus and terminal ileum, respectively.

Improvement of dietary protein utilisation in chicks by medium chain triglyceride

1. To improve the influence of variation of ME intake, an experiment was carried out using equalized feeding to investigate the comparative effects on protein and energy utilisation in chicks of diets containing medium chain triglyceride (MCT) and long chain triglyceride (LCT). Experimental diets were given at 3 different food intakes, namely, 100, 120 or 147 g/bird/10 d. The diets contained MCT or LCT on an isoenergetic basis. Maize oil and caprylic acid triglyceride respectively, were used as LCT and MCT sources. 2. Body weight gain and food efficiency of chicks significantly increased with the supplement of dietary MCT compared with dietary LCT at all food intakes. Protein retention and the efficiency of protein utilisation (protein retained/protein intake) at all food intakes also significantly increased with dietary MCT, while body fat and fat retention were significantly reduced. Chicks fed the LCT-supplemented diet, on the other hand, had a lower protein retention, but significantly higher fat retention. The value for energy retention and the efficiency of energy utilisation (energy retained/ME intake) were not significantly different between MCT- and LCT-supplemented diets. 3. It was concluded that supplementing MCT to the chick diet would improve body weight gain and protein utilisation while regulating fat deposition compared to the LCT supplemented diet, under equalized feeding conditions.