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Division of Healthcare Science Research Laboratory, Nisshin Oil Mills, Ltd., Kanagawa 239-0832, Japan;
Kagawa Nutrition University, Saitama 350-0288, Japan; and the
Institute of Environmental Science for Human Life, Ochanomizu University, Tokyo 112-8610, Japan.
**
*
1To whom correspondence should be addressed. E-mail: hiroaki.tsuji{at}nisshin-seiyu.co.jp
ABSTRACT
We investigated the effect of long-term ingestion of dietary
medium-chain triacylglycerols (MCT) on body weight and fat in
humans. Using a double-blind, controlled protocol, we assessed the
potential health benefits of MCT compared with long-chain
triacylglycerols (LCT) in 78 healthy men and women [body mass index
(BMI) 
23 kg/m2: n = 26 (MCT),
n = 30 (LCT); BMI < 23 kg/m2:
n = 15 (MCT), n = 7 (LCT)].
Changes in anthropometric variables, body weight and body fat during
the 12-wk MCT treatment period were compared with those in subjects
consuming the LCT diet. The subjects were asked to consume 9218 kJ/d
and 60 g/d of total fat. The energy, fat, protein and carbohydrate
intakes did not differ significantly between the groups. Body weight
and body fat in both groups had decreased by wk 4, 8 and 12 of the
study. However, in the subjects with BMI 23 kg/m2,
the extent of the decrease in body weight was significantly greater in
the MCT group than in the LCT group. In subjects with BMI 23
kg/m2, the loss of body fat in the MCT group (-3.86
± 0.3 kg) was significantly greater than that in the LCT group
(-2.75 ± 0.2 kg) at 8 wk. In addition, in subjects with BMI
23 kg/m2, the decrease in the area of subcutaneous
fat in the MCT group was significantly greater than that in the LCT
group at wk 4, 8 and 12. These results suggest that the MCT diet may
reduce body weight and fat in individuals (BMI 23
kg/m2) more than the LCT diet.
KEY WORDS: • fat intake • medium-chain triacylglycerols • body mass index • body fat • obesity • humans
Medium-chain triacylglycerols (MCT),2 composed of medium-chain fatty acids such as octanoic and decanoic acids, are readily hydrolyzed by lingual and gastric lipases. The medium-chain fatty acids formed are absorbed through the portal system without resynthesis of triacylglycerol in intestinal cells, are subjected predominantly to ß-oxidation in the liver, and are not stored as fat. Consequently, MCT constitute a good energy source for patients with pancreatic insufficiency and fat malabsorption as well as preterm infants with pancreatic juice and bile acid insufficiency.
Because their intramitochondrial transport of medium-chain fatty
acids does not require carnitine palmitoyltransferase (1
),
this does not represent a limiting step in their metabolism.
Consequently, MCT are oxidized more than long-chain
triacylglycerols (LCT) (2
). For these reasons, MCT could
be useful for the dietary treatment of obesity. In fact, it has been
reported that the body weight gain of rats fed MCT is less than that of
rats fed LCT (3
–5
), possibly because the oxygen
consumption of the former rats is higher than that of the latter
(6
, 7
). However, such effects have not been reported in
humans. In the present study, we assessed the potential health benefits
of MCT compared with those of LCT, using 78 healthy men and women [BMI
23 kg/m2: n = 26 (MCT),
n = 30 (LCT); BMI < 23
kg/m2: n = 15 (MCT), n
= 7 (LCT)] using a double-blind, controlled protocol. Data
from subjects with BMI 23 kg/m2 or
< 23 kg/m2 were examined based on the Japan
Society for the Study of Obesity report (8
). Changes in
anthropometric variables, body weight and body fat profiles during the
12 wk of MCT treatment were compared with those of subjects consuming
the LCT diet.
MATERIALS AND METHODS
Subjects.
The study subjects were 86 men and 15 women ranging in age from 20 to
58 y with a BMI of 24.7 ± 0.2 kg/m2. All of the
subjects were generally healthy and had no history of hypertension,
diabetes or hyperlipidemia. Most of the subjects were classified as
performing level 1 (mild) or level 2 (medium) daily activity according
to the Fifth Recommended Dietary Allowance for Japanese
(9
). Subjects who discontinued the study or who did not
maintain the regulated diet (n = 23) were excluded
from the final study analysis.
This study was carried out in accordance with the Helsinki Declaration of 1975, as revised in 1983, and was approved by the Ethics Committee of Ochanomizu University. The procedures were fully explained to all the volunteers in advance, and all gave their signed informed consent before participating.
Test diets.
MCT were purchased commercially (Nisshin Oil Mills, Tokyo, Japan).
Common edible oil, blended rapeseed oil and soybean oil (Nisshin Oil
Mills) were used as LCT. Fatty acid compositions were determined by a
gas liquid chromatography system (6890 series; Agilent Technologies,
Palo Alto, CA) with a capillary column (SP2340; Supelco, Bellefonte,
PA) after esterification. The fatty acid compositions of MCT and LCT
are given in Table 1
. Bread containing LCT or MCT was prepared and was designated as the LCT
or MCT test diet, respectively.
|
The study was carried out in a double-blind, controlled manner. Body weight, height, energy intake, fat intake and daily activity were investigated before the beginning of the study. Subjects (n = 100) were randomly assigned to the LCT or the MCT diet group. The subjects were asked to consume 9218 kJ/d and 60 g/d of total fat, and to maintain their daily exercise at a fixed level during the 12-wk experimental period.
Before starting the study, all subjects were given thorough
instructions in dietary regulation. The test diet was given only as
breakfast, and the daily intake of the test oil was set at 10 g.
The subjects were asked to consume the test diet every day throughout
the study. For breakfast, lunch and dinner every day, the subjects
consumed the same packaged meals for 12 wk under the guidance of the
dietitian. The average energy contents of breakfast, lunch and dinner
were 
1200, 3300 and 2600 kJ, respectively. The average total fat
contents of breakfast, lunch and dinner were 12, 25 and 20 g,
respectively. The subjects were ask to consume 150 g/d of fruit and 150
g/d of vegetables (630 kJ) and to consume side dishes or snacks
containing 1467 ± 210 kJ and 3 ± 2 g of fat every day.
If the subjects were unable to consume the packaged meal for any
reason, they were asked to maintain the target intake of energy and
total fat with food from a restaurant or fast food outlet. If the
subjects were unable to consume this alternative food because of
personal circumstances, individual directions were given on the basis
of the menu obtained in advance. The daily intake of alcoholic
beverages was restricted to 25 mL of ethanol equivalents.
The subjects were instructed to record the contents of daily meals,
snacks and beverages in the diet diary for the entire test. The diary
was collected weekly to confirm the meal intake, and, if necessary, the
subject was immediately instructed to adhere to the dietary regimen.
Daily intakes of energy, fat, protein, carbohydrate and fatty acids
were calculated from the diary record by the dietitian on the basis of
the Fourth Revision of the Standard Tables of Food Composition in Japan
(10
).
Anthropometric measurements.
All measurements were performed by trained investigators. The participants wore light clothing without footwear. Body weight and height were measured to the nearest 0.1 kg and 0.1 cm, respectively. Waist circumference (WC) was measured at the umbilical level. Maximum hip circumference was obtained at the level of the greatest posterior protuberance. Both waist and hip circumferences were measured to the nearest 0.1 cm in a standing position. These measurements were performed at 0, 4, 8 and 12 wk.
Blood sampling and clinical analysis.
At 0, 4, 8 and 12 wk, blood samples were collected from the subjects
between 9:30 and 11:30 h after an overnight fast from 21:00 h on the
previous day. Blood sampling and anthropometric measurements were
performed on the same day. Analyses of serum triacylglycerol,
cholesterol were carried out on a 7450 automated system (Hitachi,
Tokyo, Japan) by enzymatic methods. Analyses of serum total ketone
bodies were conducted using a JCA-BM12 automated system (JEOL, Tokyo,
Japan) by enzymatic method. Serum aspartate aminotransferase (AST; UV
method), alanine aminotransferase (ALT; UV method) and 
-glutamyl
transpeptidase (-GTP; colorimetric analysis) were assayed on a 7170
automated system (Hitachi).
Measurement of body fat.
At 0, 4, 8 and 12 wk, body fat was measured by the air-replacement
method (11
), using a MAB-1000 body densitometer (Nihon
Kohden, Tokyo, Japan).
Measurement of fat by computed tomography (CT).
The subjects underwent CT scanning within 3 d before or after
anthropometric measurements at Yokohama Red Cross Hospital (Yokohama,
Japan) using Pro Seed (GE Yokogawa Medical System, Tokyo, Japan).
Subcutaneous and visceral fat areas were determined from the CT images
at the umbilical level by the method of Tokunaga et al.
(12
).
Statistical analyses.
Values were expressed as means ± SEM. Data from the subjects with BMI over 23 kg/m2 or under 23 kg/m2 are presented individually expect for nutritional intake. The differences in raw data were examined by two-way (dietary fat groups x period) ANOVA. In addition, the significance of differences between the groups for the same period was examined by unpaired Student’s t test (two-tailed). Differences with P < 0.05 were considered significant. These statistical calculations were performed with SPSS for Windows, Version 10.0J (SPSS Japan, Tokyo, Japan).
RESULTS
Energy consumption.
There were no differences between the MCT group and the LCT group in
energy intake, nutrient intake and fat composition of the test foods
during the test period, except for (n-3) polyunsaturated fatty acids
(PUFA; Table 2
). There were no differences in energy and fat intakes before the test
period between the BMI < 23 kg/m2 and BMI
23 kg/m2 groups. During the 12-wk test
period, the energy, fat, protein and carbohydrate intakes did not
differ significantly between the groups (Table 2)
. However, the
medium-chain fatty acid intake of the MCT group was higher
(P < 0.05) than that of the LCT group. Intake of
saturated fatty acids by the LCT group, except for medium-chain
fatty acids, was higher than by the MCT group. Intakes of
monounsaturated fatty acids, (n-6) PUFA and (n-3) PUFA by the LCT group
were higher than by the MCT group.
|
Body weight in both groups decreased during the study. However, in the
subjects with BMI 23 kg/m2, the extent of
the decrease in body weight was significantly greater in the MCT group
than in the LCT group at the same time-points (Table 3
). In the subjects with BMI < 23 kg/m2, body
weight in both groups decreased but the groups did not differ. In the
subjects with BMI 23 kg/m2, WC had
decreased significantly more in the MCT group than in the LCT group
after 4 and 12 wk (Table 3)
, and the waist-to-hip ratio (WHR) in the
MCT group had decreased significantly more after 12 wk than in the LCT
group. In subjects with BMI < 23 kg/m2,
changes in WC and W/H did not differ between the groups.
|
The amount of body fat was significantly decreased at 4, 8 and 12 wk of
the study in both groups (Table 4
). In subjects with BMI 23 kg/m2, the
decrease in body fat of the MCT group (-3.86 ± 0.3 kg) was
significantly greater than that of the LCT group (-2.75 ± 0.2kg)
at 8 wk. In the subjects with BMI < 23
kg/m2, the change in body fat did not differ
between diet groups. In the subjects with BMI 23
kg/m2, the decrease in the area of subcutaneous
fat was significantly greater in the MCT group than in the LCT group at
4, 8 and 12 wk (Table 4)
. However, in subjects with BMI < 23
kg/m2, changes in subcutaneous fat area in both
groups did not differ. In the subjects with BMI 23
kg/m2, the change in area of visceral fat did not
differ significantly between the groups. However, in the subjects with
BMI < 23 kg/m2, the decrease in area of
visceral fat area of the MCT group was greater than that of the LCT
group at 12 wk.
|
In the subjects with BMI 23 kg/m2,
triacylglycerols were significantly decreased during the study. Total
cholesterol in both groups was significantly decreased after intake of
the test diets (Table 5
). However, there was no significant difference in blood lipid
composition between the groups. In contrast, in the subjects with BMI
23 kg/m2, total ketone bodies in the MCT
group were higher than in the LCT group at 8 and 12 wk. However, these
values were within the normal range. In the subjects with BMI < 23 kg/m2, total ketone body levels did not differ
between groups. AST, ALT and -GTP activities were within normal
ranges in all groups.
|
DISCUSSION
In this long-term study, we investigated the effect
of MCT on body weight and fat in healthy subjects. Obesity is an
important predictor of cardiovascular death (13
, 14
),
partly due to its close associations with increased prevalence of
hypertension, diabetes mellitus and dyslipidaemia (15
, 16
).
In contrast, BMI, WC and WHR are all useful anthropometric indices and
provide important information on cardiovascular risk. However, the
relative predictive values of these indices for obesity and
cardiovascular risk remain controversial. In Americans and Canadians,
obesity is often defined as a BMI 27–30
kg/m2 in both men and women (17
, 18
).
In 1998 the World Health Organization defined BMI values exceeding 25
and 30 kg/m2 as indicative of being overweight
and obese, respectively (19
). However, these definitions
cannot be readily applied to Asians, who often have smaller body frames
than do Americans and Canadians. It is important from a public health
perspective to determine what values of simple anthropometric
measurements are associated with the presence of adverse cardiovascular
risk factors such as diabetes, hypertension or dyslipidemia to provide
an indication for additional detailed investigations. Ko et al.
(20
) reported that risk factors for cardiovascular
disease, diabetes and hypertension were increased in Hong Kong Chinese
with BMI 23 kg/m2. The cardiovascular
disease risk factors in Asian populations may be lower risk than those
in Western populations (21
). Recently, the Japan Society
for the Study of Obesity (8
) reported that a BMI 23 kg/m2 indicates being overweight and can be
used as an objective value in the treatment of obesity in Japan.
Therefore, in this study, all data from the subjects with BMI over or
under 23 kg/m2 were presented individually,
expect for nutritional intake. In subjects with BMI 23
kg/m2, body weight and body fat in the MCT group
were significantly lower than those in the LCT group for both
measurement and 
value at 0, 4, 8 and 12 wk.
Many investigators using animal models have found that MCT can
exert slight weight-reducing effects. This has been confirmed in
many experiments performed mainly on rats, notably obese Zucker rats
(22
, 23
), but also on other animal models
(24
–27
). For example, Hashim et al. (4
)
reported that MCT-fed rats were significantly lighter and had
smaller epididymal, retroperitoneal, omental and subcutaneous fat pads
than did respective pair-fed LCT rats. These data correspond well
to our results.
In animal studies, the observed decreases in body weight have
resulted primarily from shrinkage of fat depots
(4
, 5
, 28
, 29
), leading to reduction in the relative fat
content of the whole body (22
, 30
, 31
). The number of
adipocytes seems to be independent of alimentary fat (7
)
(32
, 33
), whereas their mean size is less in MCT-fed
than in LCT-fed rats. In contrast, exogenous food supply causes a
transient increase in energy expenditure, i.e., the thermic effect of
food. Hill et al. (34
) demonstrated unequivocally that the
thermic effect of food curve of healthy volunteers was delayed and did
not return to the baseline value by 6 h after a normal meal
containing 40% energy as MCT, in contrast to the response obtained
after intake of LCT.
These conclusions, however, are far from being universally accepted,
because the promising slimming potential of MCT in humans has been
poorly documented, and clinical studies supporting this concept have
been rare and rather disappointing. In a study by Rath et al.
(35
), 24 obese women fasted for 5 consecutive days before
consuming two different hypocaloric diets for 3 wk: 12 were placed on a
550-kcal (2305 kJ) regimen providing 50 g of protein and 30 g
of MCT, and the others were placed on a 500-kcal (2095 kJ) regimen with
60 g of protein and 10 g of LCT as whipped cream. At the end
of the experiment, body weight losses were the same in the two groups.
In another clinical study, Yost and Eckel (36
) placed 16
obese women on two different hypocaloric regimens [800 kcal (3352 kJ)
and 30% energy as fat] for 4–12 wk. The first regimen comprised only
LCT, whereas the second consisted of 6% LCT and 24% MCT. Here too,
the recorded body weight losses were similar with both fats. Finally,
Hill et al. (37
) investigated 10 nonobese volunteers who
were given a regimen providing 150% of the recommended dietary
allowance for 6 d. Fats were ingested as 40% LCT or 40% MCT in a
randomized, crossover design. No significant change in body weight was
recorded at the end of either diet protocol.
The balance between body weight reduction and increase achieved
through use of a diet seems to vary widely, indicating the balance
between the two conditions needs to be substantiated more fully. For a
wide variety of reasons, the positive and negative effects of MCT on
body weight vary among experiments, although, ultimately, they are
always rather small. Hence, there have been no reports in authoritative
journals about the role of MCT in the treatment of obesity
(38
–40
).
From the existing literature, we consider that the following two
items are important. First, in general, not only intake of oil but also
total energy intake affects body weight. In previous clinical trials,
the actual energy intake was not reported, although the intake of oil
was stipulated. In this study, we stringently controlled not only the
amount of oil, but also the total energy intake under the guidance of a
dietitian. Consequently, the total daily energy intake by individual
subjects was almost the same during the study. Second, we believe that
the hepatic lipid turnover rate in obese persons (BMI 23
kg/m2) may be slower than in nonobese persons
(BMI < 23 kg/m2). Therefore, we divided the
data into those for subjects with a BMI over and under 23
kg/m2 and analyzed the results separately.
Consequently, we found that in subjects with BMI 23
kg/m2, body weight and fat in those fed MCT were
significantly lower than in those fed LCT. These results suggest that a
MCT diet may tend to reduce body weight and fat in overweight persons
(BMI 23 kg/m2) compared with a LCT diet.
ACKNOWLEDGMENTS
We acknowledge the technical guidance and advice given by F. Yamaki, S. Masuda, K. Tsuchiya, N. Taguchi, K. Yamanouchi and M. Hosaka. We thank the Kanagawa branch of the Japan Anti-tuberculosis Association for blood sampling, and Yokohama Red Cross Hospital for measurement of fat by computed tomography.
The anthropometric and body fat measurements were conducted by N. Nosaka, O. Noguchi, F. Kubota and K. Oyama. We thank T. Noro, I. Takahashi M. Itakura and Y. Kojima for nutrition stewardship and analysis.
FOOTNOTES
2 Abbreviations used: ALT, alanine
aminotrasnferase; AST, aspartate aminotransferase; BMI, body mass
index; CT, computed tomography; -GTP, -glutamyl transpeptidase;
LCT, long-chain triacylglycerols; MCT, medium-chain
triacylglycerols; PUFA, polyunsaturated fatty acid; WC, waist
circumference; WHR, waist-to-hip ratio. 
Manuscript received 30 April 2001. Initial review completed 18 June 2001. Revision accepted 22 August 2001.
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