protectives, preservation of bone mineral density, and anticancer-
ous effects in the breast, colon, and stomach.
3,18
Pickled soybean
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
Seoul, Korea
REFERENCES
1. Lichtenstein AH. Soy protein, isoflavones and cardiovascular disease risk. J Nutr
1998;128:1589
2. Nagatam C, Takatsuka N, Kurisu Y, Shimizu H. Decreased serum total choles-
terol concentration is associated with high intake of soy products in Japanese men
and women. J Nutr 1998;128:209
3. The role of soy in preventing and treating chronic diseases. Am J Clin Nutr
1998;68:1329S
4. Anthony MS, Clarkson TB, Williams JK. Effects of soy isoflavones on athero-
sclerosis: potential mechanisms. Am J Clin Nutr 1998;68:1390S
5. Aoyama T, Fukui K, Takamatsu K, Hashimoto Y, Yamamoto T. Soy protein
isolate and its hydrolysate reduce body fat of dietary obese rats and genetically
obese mice (yellow KK). Nutrition 2000;16:349
6. Ogawa T, Gatchalian-Yee M, Sugano M, et al. Hypocholesterolemic effect of
undigested fraction of soybean protein in rats fed no cholesterol. Biosci Biotech
Biochem 1992;56:1845
7. Forsythe WA. Comparison of dietary casein or soy protein effects of plasma
lipids and hormone concentrations in the gerbil (Meriones unguiculatus). J Nutr
1986;116:1165
8. Iritani N, Hosomi H, Fukuda H, et al. Soybean protein suppresses hepatic
lipogenic enzyme gene expression in Wistar fatty rats. J Nutr 1996;126:380
9. Tovar-Palacio C, Potter SM, Hafermann JC, Shay NF. Intake of soy protein and
soy protein extracts influences lipid metabolism and hepatic gene expression in
gerbils. J Nutr 1998;128:839
10. Morita T, Oh-hashi A, Takei K, et al. Cholesterol-lowering effects of soybean,
potato and rice proteins depend on their low methionine contents in rats fed a
cholesterol-free purified diet. J Nutr 1997;127:470
11. Young VR. Soy protein in relation to human protein and aminoacid nutrition.
J Am Diet Assoc 1991;91:828
12. Kawano-Takahashi Y, Ohminami H, Okuda H, et al. Effect of soya saponins on
gold thioglucose-induced obesity in mice. Int J Obes 1986;10:293
13. Allara L. The return of the high-protein, low-carbohydrate diet: Weighing the
risks. NCP 2000;15:26
14. Saito M. Effect of soy peptides on energy metabolism in obese animals. Nutr Sci
Soy Protein 1991;12:91
15. Rowe MI, Stein JS, Lee MD, Cook DR. Effects of muscle relaxants, sedatives,
narcotics and anesthetics on non-shivering thermogenesis. Surg Forum 1987;
38:76
16. Slavin J. Nutritional benefits of soy protein and soy fiber. J Am Diet Assoc
1991;91:816
17. Setchell KD. Phytoestrogens: the biochemistry, physiology, and implications for
human health of soy isoflavones. Am J Clin Nutr 1998;68:1333S
18. Lee MD, Kim YI, Kim JP. An experimental study on the development of gastric
cancer by maejoo (Korean fermented soybean cake), aflatoxin B
1
and N-methyl-
NЈ-nitro-N-nitrosoguanidine in rats. J Kor Med Assoc 1982;25:149
PII S0899-9007(00)00357-9
Use of Medium-Chain
Triacylglycerols in Parenteral
Nutrition of Children
More than 10 y ago, Panteliadis et al.
1
and Jalili
2
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.
3–5
Since
then, only very few investigations have shown the effects of
parenteral MCT in children.
6–10
Most of the major in vivo studies
in humans have been undertaken with adult patients.
11–24
The
results of these reports have been reviewed in this journal.
25,26
Both Ulrich et al.
25
and Carpentier et al.
26
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
subjects,
11
surgical patients,
12,15,16,18,20,21,24
critically ill pa-
tients,
14,17,23
patients with liver diseases,
13,19
and patients suffering
from AIDS,
22
among others. In contrast, almost all studies in
children have examined premature infants
1,6–8,10
or newborns,
1–5,9
the only exception being Goulet et al.
7
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
12,22
or cytokine levels
17,22
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
9,16,21
have
Correspondence to: Charis Papavassilis, MD, Zentrum fuer Dermatologie
und Andrologie, Gaffkystrasse 14, D-35385 Giessen, Germany. E-mail:
charis.papavassilis@derma.med.uni-giessen.de
460 Editorial Opinions Nutrition Volume 16, Number 6, 2000