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Inclusion of 10% fish oil in mixed medium-chain triacylglycerol–long-chain triacylglycerol emulsions increases plasma triacylglycerol clearance and induces rapid eicosapentaenoic acid (20:5n–3) incorporation into blood cell phospholipids^1,2,3

¹ From the L Deloyers Laboratory for Experimental Surgery, Université Libre de Bruxelles, Brussels, Belgium (CMS and YAC); the Department of Gastrointestinal Surgery (CMS) and the Intensive Care Unit (JJM), CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; and the Institute of Human Nutrition, Columbia University, New York, NY (RJD)

Background:Lipolysis of a fish oil (FO) emulsion is much slower than that of a soybean [long-chain triacylglycerol (LCT)] emulsion; in contrast, emulsions containing medium-chain triacylglycerol (MCT) are efficiently hydrolyzed by lipoprotein lipase.

Objectives:We questioned whether incorporating 10% FO in a mixed MCT-LCT emulsion would affect plasma triacylglycerol clearance and provide efficient delivery of n–3 polyunsaturated fatty acids to cells and tissues.

Design:This prospective crossover study was conducted in 8 normolipidemic subjects with the use of the hypertriglyceridemic clamp model and compared plasma triacylglycerol clearance of a lipid emulsion (5:4:1) made of 50% MCT, 40% LCT, and 10% FO (wt:wt:wt) to a control (5:5) preparation with 50% MCT and 50% LCT. Subjects were daily infused for 5 h, over 4 consecutive days. Fatty acyl pattern was daily measured in plasma phospholipids as well as in leukocyte and platelet phospholipids.

Results:Inclusion of 10% FO in mixed emulsion particles enhanced plasma clearance of infused triacylglycerols (18%; P < 0.0001). The faster elimination of the 5:4:1 emulsion appears related to an enhanced uptake of remnant particles rather than to faster intravascular lipolysis. Each infusion of 5:4:1 raised the eicosapentaenoic acid (C20:5n–3) concentration in blood cell phospholipids to reach a 7-fold enrichment in platelets and a >2-fold enrichment in leukocytes after 4 infusions. In contrast, the docosahexaenoic acid (C22:6n–3) concentration remained unchanged in blood cell phospholipids.

Conclusions:Infusion of a mixed emulsion with MCTs, soy LCTs, and FO is associated with efficient plasma triacylglycerol clearance and results in rapid incorporation of C20:5n–3 but not C22:6n–3 in leukocyte and platelet phospholipids.