Hainer V, Kunesová M, Stich V, Zák A, Parizková J
IV. interní klinika 1. LF UK a VFN, Praha.
Cas Lek Cesk. 1994 Jun 13;133(12):373-5.
Treatment of obesity with strict reducing diets is as a rule associated with the development of energetic efficiency manifested among others also by a decline of energy expenditure. The objective of the trial was to test whether addition of oils containing triacylglycerols with medium-chain fatty acid can prevent this decline and whether their administration can affect the lipid spectrum.
Sixty obese patients were served for a four-week period of hospitalization at the obesitology unit a low-energy diet REDITA (Promil Co., N. Bydzov) providing 1596 kJ, 37 g protein, 50 g carbohydrate and 3 g fat. Part of the treatment was regular aerobic exercise, behavioural therapy to teach correct dietary habits and physical activity; physical activity was monitored by means of pedometers. From this group during the 3rd and 4th week 11 patients with similar characteristics were separated (age, body weight, BMI and energy expenditure at rest) as in the basic group. These patients were given daily 15 ml oil containing triacylglycerols with medium-chain fatty acids, MCT OIL (Mead Johnson, Evansville), providing 545 kJ. The resting energy expenditure was assessed in all patients every morning on fasting, immediately after awakening, using indirect calorimetry and it was corrected with regard to the respiratory quotient and excretion of catabolic nitrogen. The body composition was assessed at the beginning and at the end of the trial by hydrostatic weighing. Administration of oil containing triacylglycerols with medium-chain fatty acids (MCT OIL) prevented the decline of the resting energy expenditure (130.0 +/- 9.2 kJ/kg lean body mass/day, as compared with 126.5 +/- 7.2 kJ/kg lean body mass/day in the basic group: the difference is statistically not significant). Although addition of oil increased the energy intake by 545 kJ/day, the drop of body weight and BMI was comparable with that in the group of obese patients who did not receive the oil (10.3 +/- 1.1 kg vs. 10.6 +/- 0.5 kg). While during administration of the oil the resting energy expenditure did not change (5.97 +/- 0.30 kJ/min. vs. 5.24 +/- 0.58 kJ/min.), in obese patients who were only on the strict reducing diet it declined from 5.45 +/- 0.18 kJ/min. to 4.44 +/- 0.22 kJ/min. (p < 0.01). The significant drop of total cholesterol achieved by dietotherapy alone (5.41 +/- 0.21 mmol/l vs. 6.26 0.20 mmol/l before treatment) was not affected by administration of oil (4.86 +/- 0.28 mmol/l vs. 5.69 +/- 0.35 mmol/l before treatment). HDL-cholesterol, on the other hand, declined only in obese patients with dietotherapy (1.40 +/- 0.04 mmol/vs. 1.22 +/- 0.04 mmol/l after treatment, p < 0.01). The triacylglycerol values declined significantly in both groups (p < 0.01).
It appears that administration of thermogenetically acting triacylglycerols with medium-chain fatty acids can prevent diet-induced energetic efficiency and can improve the long-term success of dietotherapy of obese patients.
通常情况下，采用严格的节食疗法治疗肥胖症会伴随着能量效率的变化，其中能量消耗下降就是表现之一。本试验的目的是测试添加含有中链脂肪酸的三酰甘油油是否可以防止这种下降，以及其给药是否会影响血脂谱。
60名肥胖患者在肥胖症治疗单元接受了为期四周的住院治疗，采用低能量饮食REEDITA（Promil公司，N. Bydzov），提供1596千焦、37克蛋白质、50克碳水化合物和3克脂肪。治疗的一部分包括定期有氧运动、行为疗法以教授正确的饮食习惯和体育活动；通过计步器监测体育活动。在第3周和第4周，从该组中分离出11名与基础组特征相似的患者（年龄、体重、BMI和静息能量消耗）。这些患者每天服用15毫升含有中链脂肪酸的三酰甘油油，即MCT油（美赞臣公司，埃文斯维尔），提供545千焦能量。每天早晨在所有患者禁食、刚醒来后，使用间接测热法评估静息能量消耗，并根据呼吸商和分解代谢氮排泄进行校正。在试验开始和结束时通过水下称重评估身体成分。服用含有中链脂肪酸的三酰甘油油（MCT油）可防止静息能量消耗下降（瘦体重每天每千克130.0±9.2千焦，而基础组为126.5±7.2千焦/千克瘦体重/天：差异无统计学意义）。虽然添加油使能量摄入每天增加545千焦，但体重和BMI的下降与未接受油的肥胖患者组相当（10.3±1.1千克对10.6±0.5千克）。在服用油期间，静息能量消耗没有变化（5.97±0.30千焦/分钟对5.24±0.58千焦/分钟），而仅采用严格节食的肥胖患者静息能量消耗从5.45±0.18千焦/分钟降至至4.44±0.22千焦/分钟（p<0.01）。单独通过饮食疗法使总胆固醇显著下降（治疗前为6.26±0.20毫摩尔/升，治疗后为5.41±0.21毫摩尔/升），但服用油对此无影响（治疗前为5.69±0.35毫摩尔/升，治疗后为4.86±0.28毫摩尔/升）。另一方面，高密度脂蛋白胆固醇仅在接受饮食疗法的肥胖患者中下降（治疗前为1.40±0.04毫摩尔/升，治疗后为1.22±0.04毫摩尔/升，p<0.01）。两组中的三酰甘油值均显著下降（p<0.01）。
似乎服用具有产热作用的含有中链脂肪酸的三酰甘油可以防止饮食引起的能量效率下降，并可以提高肥胖患者饮食疗法的长期成功率。
