protectives, preservation of bone mineral density, and anticancer-
ous effects in the breast, colon, and stomach.
has been popularized in folk remedies in Korea for obesity.
In Asia, soy foods are consumed regularly as tofu (bean curd),
yu-fu (aburake, fried bean curd), miso (maezoo or doenzang,
fermented soy paste), soy sauce, bean ﬂour, bean sprouts, and even
tofu cookies (Western). The number of people who enjoy soy-
foods, the number of recipes that call for soyfoods, and the
frequency with which it is eaten are limited in Western countries.
The incidences of hypercholesterolemia, atherosclerosis, and car-
diovascular accidents (Western diseases) in developing countries
have increased concurrently with increases in wealth, the avail-
ability of Western food, and obesity. Everyone needs to be more
interested in soyfoods and in investigating how soybeans work.
Myung-Duk Lee, MD, PhD, FACS
In-Chul Kim, MD, PhD, FACS
Department of Surgery
Kangnam St. Mary’s Hospital
The Catholic University of Korea
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Use of Medium-Chain
Triacylglycerols in Parenteral
Nutrition of Children
More than 10 y ago, Panteliadis et al.
were the ﬁrst to
report their experiences with the use of lipid infusions containing
medium-chain triacylglycerols (MCTs) for parenteral nutrition in
infants. Three more studies were reported the next year.
then, only very few investigations have shown the effects of
parenteral MCT in children.
Most of the major in vivo studies
in humans have been undertaken with adult patients.
results of these reports have been reviewed in this journal.
Both Ulrich et al.
and Carpentier et al.
asked for larger studies
to better evaluate the actual clinical beneﬁt of MCT and long-chain
triacylglycerol (LCT) infusions compared with infusions consist-
ing only of LCTs. In adults, this call has been answered by
studying many different groups of patients, including healthy
critically ill pa-
patients with liver diseases,
and patients suffering
among others. In contrast, almost all studies in
children have examined premature infants
the only exception being Goulet et al.
The investigation reported by Lai et al. in this issue of Nutrition
is the ﬁrst study in a relatively homogeneous group of young
children undergoing major gastrointestinal surgery. With 40 pedi-
atric subjects, it is also one of the largest studies undertaken thus
far. The investigators have monitored their patients intensively,
determining parameters for liver and renal function, blood cells,
blood lipid parameters, and urinary parameters. In addition, indi-
rect calorimetry was performed. Taken together, these data al-
lowed a close look at lipid and protein metabolism. The results
show postive effects of MCT/LCT mixes with regard to liver
function and nitrogen balance. Fats were better used and protein
was spared in this group. The study strongly suggests that paren-
teral nutrition with lipid infusions containing 50% MCT in their
lipid content is safe in pediatric surgical patients. This is very
important information, because the investigators have managed to
investigate this notoriously difﬁcult-to-study population of chil-
dren. Nevertheless, even this carefully undertaken study does not
shed enough light on the question of clinical relevance of the
laboratory results, because no correlation between these results and
clinical outcome has been reported. The interpretation of immu-
nologic ﬁndings such as white blood cell counts and functions
or cytokine levels
remain especially difﬁcult, and even more
so because different groups have reported controversial data.
Although most data suggest strong beneﬁts of MCT/LCT mix-
tures over LCT infusions, some concerns have to be raised. In
mechanically ventilated patients, MCT infusions should be given
over a longer period than LCT infusions to compensate for the
increase in metabolic demand. Because some MCTs, especially
C8:0, have been shown to be neurotoxic, patients with an impaired
blood–brain barrier should receive only small amounts of these
fatty acids. Because the choice of triacylglycerol mixture for
parenteral nutrition seems to have immunologic effects, immuno-
compromised patients and patients with inﬂammatory and infec-
tious diseases should be monitored intensively and the decision
which lipid infusion to use should be weighed carefully.
Although studies such as the one by Lai et al. point to the right
direction, many more aspects of the problem of parenteral lipid
nutrion with MCT remain to be investigated. Whereas Lai et al.
used 10% lipid content in the infusion, some studies
Correspondence to: Charis Papavassilis, MD, Zentrum fuer Dermatologie
und Andrologie, Gaffkystrasse 14, D-35385 Giessen, Germany. E-mail:
460 Editorial Opinions Nutrition Volume 16, Number 6, 2000