Search Results (128)

Background: Severe hypertriglyceridemia (SHTG) in children is a rare but clinically significant disorder associated with recurrent acute pancreatitis and substantial morbidity. Early identification and prompt management are essential to prevent pancreatic and systemic complications. Methods: We report the case of an 11-year-old female with a history of xanthogranulomatous pancreatitis who presented with extreme hypertriglyceridemia, with fasting triglyceride levels exceeding 4000 mg/dL. Results: The patient was treated acutely with continuous intravenous aspart insulin (0.1 U/kg/hour) and adjusted 10% glucose infusion, with hourly glucose and potassium monitoring, leading to a rapid and marked reduction in triglyceride levels—55% reduction within the first 24 h, 76% at 48 h, and 82% after 96 h of treatment. No hypoglycemia or other adverse effects were observed. Nutritional management included a low–long-chain triglyceride (LCT) diet enriched with medium-chain triglycerides (MCTs) and omega-3 fatty acids, providing essential calories while minimizing chylomicron production. Over a 12-month follow-up, the patient remained asymptomatic, with sustained lipid normalization and no recurrence of pancreatitis. Conclusions: This case underscores the therapeutic value of combining pharmacologic and dietary strategies in pediatric SHTG. Evidence from pediatric and adult studies supports the role of insulin infusion for acute triglyceride lowering and MCT-based nutritional therapy for long-term control. Our findings highlight the need for early, individualized, and multidisciplinary management and emphasize the potential future role of emerging targeted therapies in addressing refractory pediatric hypertriglyceridemia. Full article

Background: Standard ketogenic diets (KD) and fish oil have established efficacy for drug-resistant epilepsy (DRE), but adherence and variability remain challenging. Objective: The objective of this study is to provide the first systematic evaluation of clinical evidence for emerging dietary interventions for epilepsy—specifically those other than standard KD and fish oil—and to rigorously evaluate their effectiveness and certainty of evidence to address the current gap in dietary management literature. Unlike prior reviews focused on standard KD or carbohydrate-modified versions, this study is the first to synthesize evidence for “non-standard” interventions—including olive oil-based KDs, probiotics, and restrictive gluten/glutamate-free diets—which are typically excluded from traditional dietary meta-analyses. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Web of Science, Cochrane, and Google Scholar up to March 2025. Randomized Controlled Trials (RCTs) and Non-Randomized Studies of Interventions (NRSIs) were included, with quality assessed using RoB 2 and ROBINS-I tools. Results: Eight studies (total n = 675) were identified, comprising 2 RCTs and 6 NRSIs. These included olive oil-based KDs (n = 1), probiotic/synbiotic supplementation (n = 2), medium-chain triglyceride (MCT) additions (n = 2), and gluten-free (n = 1) or glutamate-free (n = 1) diets. Evidence quality is generally low, with 75% of studies at high risk of bias. Preliminary responder rates reached 83.1% in uncontrolled olive oil-based KD studies, whereas the only RCT evaluating a low-glutamate diet showed no significant seizure reduction (p = 0.57). Conclusion: Evidence for emerging dietary interventions beyond standard KD is nascent and of low certainty. Interpretation: While preliminary signals exist for olive oil-based KDs and probiotics, current data are insufficient for clinical recommendation; this review identifies these as promising exploratory targets requiring validation through rigorous, blinded RCTs. Full article

Background/Objectives: Baricitinib, a selective JAK1/JAK2 inhibitor, shows therapeutic potential in psoriasis; however, its oral use is associated with systemic adverse effects, encouraging the development of topical formulations. This study aimed at evaluating the influence of petrolatum type on the stability, biopharmaceutical performance, and therapeutic activity of lipid-based formulations containing Baricitinib. Methods: Formulations were prepared with Labrafac^® Lipophile WL 1349 (L) and either liquid (LLV) or solid (LSV) petrolatum at 30% and 60% w/w. Stability, rheology, spreadability, in vitro release, ex vivo permeation, and skin retention were evaluated, along with the safety and efficacy in HET-CAM and imiquimod-induced psoriasis murine models. Results: Only 30% petrolatum formulations remained stable for 60 days. LLV exhibited Newtonian flow, higher spreadability, sustained release (83.7% at 50 h), and superior skin retention (94 µg/g of skin/cm²), whereas LSV showed pseudoplastic behavior, lower spreadability, and reduced release (47.4% at 50 h). Both formulations were non-irritant and improved stratum corneum hydration while reducing transepidermal water loss. In vivo, both reduced erythema, epidermal thickening, edema, and histological alterations, confirming anti-inflammatory efficacy. Conclusions: These results demonstrate that the vehicle occlusivity decisively modulates baricitinib’s release and activity. LLV formulation favored drug retention and enhanced permeation at 24 h. Overall, excipient selection is important in designing safe and effective topical JAK inhibitor formulations. Full article

Lycopene is a naturally potent lipophilic antioxidant, which limits its bioavailability for absorption during intestinal digestion. Therefore, this study utilized a self-emulsifying delivery system (SEDS) to enhance the solubility and bioavailability of lycopene and investigated the effects of nonionic surfactant mixtures at varying hydrophilic–lipophilic balance (HLB) values and surfactant-to-oil ratios (SORs) on SEDS using oleic acid (OA), medium-chain triglycerides (MCTs), and sunflower oil (SO) as oil matrices. The resulting water-in-oil-in-water emulsions exhibited droplet sizes (181.70 to 572.27 nm), polydispersity indices (0.29 to 0.86), and ζ-potentials (−22.90 to −53.70 mV), with stability varying according to the type of oil and formulation parameters. Antioxidant activities of SO-based SEDS were higher compared to MCT-based and OA-based ones due to lycopene loading increase. In vitro simulated intestinal digestion revealed differences in lipolysis kinetics, with MCT-based lycopene-loaded SEDS exhibiting enhanced cumulative release and bioaccessibility in the duodenal (1.1–2.1 mEq/g) and jejunal (1.6–2.2 mEq/g) segments. This study revealed a comprehensive strategy encompassing lycopene extracts, SEDS preparation, quality indices, lipolysis dynamics, and proximal intestine solubilization amounts that successfully enhanced lycopene bioavailability. Optimized MCT-based lycopene-loaded SEDS with high HLB (10.72) and SOR (1.00) enhanced hydrophobic bioactive delivery efficiency, offering a novel low-energy strategy for developing functional supplements. Full article

Background: Lutein and zeaxanthin (LZ) are macular xanthophyll carotenoids with antioxidant and blue-light filtering properties, but their oral bioavailability is limited. Lipid-based delivery systems may enhance absorption. Methods: We compared four single-dose LZ delivery systems in male Sprague–Dawley rats: (G1) LZ in medium-chain triglyceride (MCT) oil; (G2) LZ in MCT + phosphatidylcholine (PC); (G3) LZ in MCT + phosphatidylserine (PS); (G4) LZ in liposomal powder. Following an overnight fast, each group (n = 6) received an oral gavage of the assigned formulation. Serial blood samples were collected up to 24 h post-dose. Plasma lutein + zeaxanthin concentrations were quantified by a validated LC–MS/MS method. Non-compartmental pharmacokinetic (PK) parameters were computed (Phoenix WinNonlin^®), and one-way ANOVA was used to make inter-group comparisons on ln-transformed metrics with Dunnett’s post hoc tests. Results: The PS-complexed formulation (G3) yielded the highest LZ exposure (mean C_max 69.63 ± 0.78 ng/mL; AUC_0-t 620.23 ± 16.41 ng·h/mL), significantly exceeding the MCT oil control (G1: 52.54 ± 0.70 ng/mL; 494.51 ± 13.70 ng·h/mL; p < 0.001). The PC-enriched oil (G2) and liposomal powder (G4) also produced higher C_max and AUC than G1 (p < 0.01). No differences in elimination half-life (t1/2 ≈ eight h) were observed between formulations. Conclusions: Phospholipids, especially PS, substantially improved the systemic availability of lutein and zeaxanthin compared with MCT oil alone. PS-based lipid complexes appear particularly effective, supporting their use in ocular-health formulations to maximise xanthophyll bioavailability. Full article

This study aimed to evaluate the effects of medium-chain triglyceride (MCT) emulsions enriched with hemp-derived phytocannabinoids, with or without monolaurin, on neonatal piglet growth, health, and behavior. Trial 1 used an augmented factorial design with 75 sows and 1063 piglets to compare a baseline MCT emulsion (MCTE) with a phytocannabinoid-supplemented emulsion (MCTE-P) at low or high doses against toltrazuril control. All MCT emulsions improved key performance indicators such as weight gain and survival rates compared to the control group. In particular, live-born piglets at 24 h in the MCTE-P groups showed significantly greater body weight gain and colostrum intake compared with controls (p < 0.05). While overall pre-weaning mortality rates were similar across groups, the incidence of diarrhea- and starvation-related deaths was significantly lower in MCTE-P piglets (p < 0.05). Based on these results, Trial 2 involved 36 sows and 509 piglets assigned to three groups: low-dose MCTE-P (the optimal regimen from Trial 1), low-dose MCTE-P supplemented with monolaurin (MCTE-PM), and a toltrazuril control. Both MCTE-P and MCTE-PM improved average daily gain at weaning relative to the control group. MCTE-PM showed the lowest pre-weaning mortality (14.3%) and diarrhea-related deaths (0.86%), compared with 29.4% and 10.4% in controls, respectively (p < 0.05). Hematological analyses indicated that eosinophil percentages were lowest in the MCTE-PM group (p < 0.05), while serum total protein and globulin concentrations remained elevated in emulsion-treated piglets (p < 0.001). Behavioral assessments of 108 low-birth-weight piglets showed prolonged latency to first suckling in emulsion-treated groups, while teat competition and facial lesion scores, reflecting aggressive interactions, were reduced compared with controls. Overall, these findings demonstrate that MCT emulsions supplemented with phytocannabinoids and monolaurin improved growth and survival in neonatal piglets, especially those of low to medium birth weight, and highlight their potential as nutraceutical alternatives to antibiotic prophylaxis in swine production. Full article

Background/Objectives: The efficacy of exclusive enteral nutrition (EEN) on the induction of remission of Crohn’s disease (CD) has been demonstrated with different diets (elemental, semi-elemental, and polymeric). A narrative review was conducted to assess the effects of different enteral diets in pediatric CD patients, considering the hypothesis that manipulating the nutritional key ingredients may enhance the clinical efficacy. Methods: An extensive literature search was performed across PubMed, Embase, and the Cochrane Library, covering all records published up to 27 July 2025. Both pediatric and adult studies were considered, and nutritional composition was compared with remission rates. Results: Twelve studies involving patients with active CD treated with EEN were found. Most studies were conducted with polymeric diets (n = 8), which achieved a high remission rate (up to 85%), thus confirming their advantage over other EEN diets. Conclusions: EEN with polymeric diets satisfies the need to revert the acute inflammation in most pediatric CD patients. Polymeric formulas have two advantages: (a) they contain transforming growth factor-β (TGF-β), which exerts anti-inflammatory effects on intestinal epithelial cells, and (b) they have a mixed-fat composition, including saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs) as well medium-chain triglycerides (MCTs), which provides better results than EEN diets enriched with single-fat components. However, pathophysiological evidence shows gut microbiota alterations after EEN begins, despite clinical improvement. So, a potential strategy to enhance the efficacy of polymeric diets may be fiber enrichment. Full article

Background/Objectives: Exogenous ketone supplements elevate circulating ketones without carbohydrate restriction, but their long-term hepatic safety remains unclear. This study evaluated the formulation-dependent impact of chronic ketone supplementation on liver histopathology, inflammatory signaling, and systemic biomarkers in rats. Methods: Male Sprague-Dawley rats were orally administered 1,3-butanediol (BD), medium-chain triglycerides (MCTs), ketone ester (KE), ketone electrolytes/salts (KSs), or a ketone salt–MCT combination (KSMCT) for 4 weeks. In a separate arm, animals received standard diet (SD), or SD supplemented with low-dose KE (LKE) or high-dose KE (HKE), for 83 days. Liver structure was assessed by hematoxylin and eosin staining with quantification of red blood cell density and lipid accumulation. Inflammatory and metabolic responses were evaluated by TNF-α and arginase immunohistochemistry. Serum biochemistry included glucose, proteins, electrolytes, and liver and kidney function markers. Results: BD and KE induced macrovesicular steatosis, vascular congestion, and elevated TNF-α and arginase expression, consistent with hepatic stress. MCT caused moderate hepatocellular ballooning and lipid deposition, whereas KS preserved near-normal hepatic morphology. KSMCT produced intermediate effects, reducing lipid accumulation and TNF-α compared with MCT or KE alone. KE supplementation caused dose-dependent reductions in globulin and elevations in creatinine, while HKE reduced sodium and glucose levels. Conclusions: Chronic hepatic responses to exogenous ketones are highly formulation dependent. KS demonstrated the most favorable safety profile under the tested conditions, maintaining normal hepatic structure, while BD and KE elicited adverse changes. Formulation choice is critical for the safe long-term use of exogenous ketones. Full article

Background: The ketogenic diet (KD), a high-fat and low-carbohydrate dietary approach, has been used therapeutically in drug-resistant epilepsy and other neurological and metabolic disorders. Recent interest has shifted toward understanding its broader metabolic effects through metabolomics. This review aims to summarize current knowledge on the biochemical mechanisms and therapeutic implications of the KD, with a particular focus on metabolomic profiling and neurological health. Methods: This narrative review synthesizes findings from the last five years of metabolomic studies investigating the biochemical consequences of the KD and its variants, including the classical KD, modified Atkins diet (MAD), medium-chain triglyceride diet (MCT), and low glycemic index treatment (LGIT). The review integrates data on analytical techniques, such as liquid chromatography–mass spectrometry (LC-MS) and gas chromatography–mass spectrometry (GC-MS), and evaluates alterations in key metabolic pathways. Results: The KD significantly modulates energy metabolism, shifting adenosine triphosphate (ATP) production from glycolysis to fatty acid oxidation and ketone body utilization. It affects mitochondrial function, one-carbon metabolism, redox balance, neurotransmitter regulation, and gut–brain axis signaling. Metabolomic profiling has identified β-hydroxybutyrate (βHB) as a key regulatory metabolite influencing mitochondrial respiration. Long-term KD use may impact renal and hepatic function, necessitating clinical caution and individualized nutritional monitoring. Conclusions: Metabolomic analysis provides critical insights into the multifaceted effects of the KD, supporting its role as a targeted metabolic therapy in neurological diseases. However, potential risks linked to prolonged ketosis warrant further investigation. Future studies should focus on personalized applications and long-term safety profiles of KD variants across patient populations. Full article

Chronic pancreatitis (CP) precipitates complex malnutrition through synergistic mechanisms: exocrine pancreatic insufficiency–driven maldigestion, duodenal or pancreatobiliary strictures limiting nutrient flow, cholestasis impairing micelle formation, alcohol-related anorexia, pain-induced hypophagia, proteolytic catabolism from type 3c diabetes, and a chronic inflammatory milieu that accelerates sarcopenia and bone demineralisation. Consequent calorie–protein depletion, micronutrient and fat-soluble vitamin deficits, and metabolic derangements markedly amplify morbidity. Pancreatic enzyme replacement therapy (PERT) with targeted micronutrient repletion is foundational; high-protein regimens co-administered with PERT curb muscle loss, and medium-chain triglycerides (MCTs) can augment caloric delivery by bypassing lipase dependence, although their benefit over personalised dietetic counselling is marginal. Optimal dietary fat thresholds and timing of escalation from oral to enteral or parenteral feeding remain unresolved. Comprehensive care also demands alcohol abstinence, effective analgesia and stringent glycaemic control. Serial monitoring—biochemical indices, densitometry, dual-energy X-ray absorptiometry and imaging-based body-composition metrics—permits early detection of high-risk patients and precision tailoring of interventions. Intensified multidisciplinary programmes already improve prognostic endpoints and are unveiling biomarkers of nutritional resilience. A structured, evidence-based strategy integrating PERT, macronutrient engineering, micronutrient repletion and metabolic surveillance is essential to mitigate nutrition-related morbidity, enhance long-term outcomes and optimise quality of life in CP. Full article

Background/Objectives: Fasting-induced elevation of blood ketone body levels suppresses allergic reactions; however, the underlying mechanism remains unclear. This study investigated whether elevated ketone body levels affect allergic contact dermatitis (ACD) and explored nutritional interventions that effectively increase β-hydroxybutyrate (BHB) levels. Additionally, we examined the role of GPR109A, a receptor for β-hydroxybutyrate (BHB), in ketone body-induced allergy suppression through ingestion of a ketogenic substrate. Methods: To evaluate the effects of ketone body precursors, medium-chain triglyceride (MCT) oil or 1,3-butanediol (BD) was administered as a single oral dose (2 g/kg body weight) under fed conditions. Blood BHB concentrations were measured at the time of euthanasia. ACD was induced using 2,4-dinitrofluorobenzene (DNFB), and its severity was assessed by measuring ear swelling and mast cell (MC) degranulation. To determine whether GPR109A mediates ketone body-induced allergy suppression, mepenzolate bromide (MPN), a GPR109A antagonist, was subcutaneously administered before BD treatment. Results: Both MCT oil and BD significantly increased the blood BHB levels. Elevated BHB concentrations were accompanied by reduced ear swelling and MC degranulation in DNFB-treated mice. The anti-allergic effects of BD were abolished by MPN administration, indicating that these effects were mediated by GPR109A activation. Conclusions: Nutritional supplementation with ketogenic substrates, such as MCT oil and BD, may serve as a dietary intervention for ACD by elevating blood BHB levels. GPR109A activation appears to be involved in ketone body-induced allergy suppression, suggesting a mechanistic link between ketone metabolism and immunomodulation. Full article

Medium-chain fatty acid triglycerides (MCTs) possess antibacterial, antiviral, nutritional, and other biological activities and have demonstrated significant application potential in humans and terrestrial animals. In recent years, with the development of the green aquaculture industry, MCTs have been gradually applied to aquaculture animals, which can enhance growth performance, improve flesh quality, regulate lipid metabolism, boost immune activity, and modulate the intestinal flora, thereby improving the production efficiency of aquaculture. This paper elaborates in detail on the biological activities of MCTs and their applications in aquatic animals, providing a theoretical and practical basis for the application of MCTs in aquaculture. Full article

Background: The long-term clinical and laboratory results of a 33-year follow-up of a Greek family with abetalipoproteinemia (ABL) are described. Case Report: The patients (two brothers and their sister, aged 57, 49, and 62 years, respectively) are still alive, being under close surveillance. In two of the three patients, diarrhea appeared in early infancy, while in the third, it appeared during adolescence. CNS symptomatology worsened after the second decade of life. At the same time, night blindness appeared in the advanced stages of the disease, resulting in almost complete loss of vision in one of the male patients and severe impairment in the other. The diagnosis was based on the clinical picture, ophthalmological findings, serum lipid estimations, and presence of peripheral acanthocytosis. All patients exhibited typical serum lipidemic profile, ophthalmological findings, and acanthocytes in the peripheral blood. During the follow-up period, strict dietary modifications were applied, including the substitution of fat with medium-chain triglycerides (MCT oil). After 33 years since the initial diagnosis, all patients are alive without any sign of liver dysfunction despite continuous use of MCT oil. However, symptoms from the central nervous system and vision impairment worsened. Conclusion: The course of these patients suggests that the application of a modified diet, including MCT oil, along with close surveillance, could prolong the survival of patients without significant side effects from the liver. Full article

Background: Self-emulsifying drug delivery system (SEDDS) is widely used to improve the oral bioavailability of hydrophobic drugs. Emulsion droplet size was revealed to be a critical parameter that influences the thermodynamic stability, drug solubility, and drug absorption of the SEDDS. A high proportion of surfactant and/or co-surfactant was usually employed to reduce the particle size, which may lead the low drug loading and undesirable gastrointestinal toxicity. Methods: This manuscript proposed a novel strategy to reduce the particle size of emulsions using the hybrid of medium and long-chain triglyceride (MCT and LCT) SEDDS without promoting the concentration of surfactants and co-surfactants. The composition of SEDDS was selected based on the drug solubility. Particle size distribution and zeta potential of emulsion particles were determined using the dynamic light scattering technique. The bioavailability of formulations was evaluated in a mouse model. Results: The particle size of the emulsion was reduced from 113.50 ± 0.34 nm (MCT SEDDS) and 371.60 ± 6.90 nm (LCT SEDDS) to 21.23 ± 0.30 nm (MCT&LCT SEDDS). Progesterone, a poorly water-soluble drug, was selected as the model drug in the investigation of SEDDS. The hybrid of MCT&LCT progesterone SEDDS exhibited reduced particle size, enlarged self-emulsifying ranges, and increased drug content in the aqueous phase after lipolysis compared with the conventional mono-MCT or LCT SEDDS. In addition, the bioavailability of progesterone in the MCT&LCT SEDDS formulation was 3.82-fold higher than that of Utrogestan^® (a clinical oral administrated product) in a mouse model. Full article

Medium chain triglycerides (MCTs) are regarded as an important ingredient for functional foods and nutraceuticals. Cinnamomum camphora seed kernel oil (CCSKO) contains more than 95% medium chain fatty acids (MCFAs), which is a significantly higher level than palm kernel oil (62%) and coconut oil (55%). However, the safety assessment of CCSKO, as the only natural MCT oil rich in capric acid and lauric acid found so far in the world, has not been fully verified. The study aimed to investigate the 90-day sub-chronic oral toxicity and teratogenicity of CCSKO. In the sub-chronic oral toxicity study, no clinically significant adverse events occurred in male or female Sprague–Dawley (SD) rats with CCSKO daily administration for 13 weeks. Moreover, there were no dose–response relationships between CCSKO and body-weight gain, food intake and food utilization in male or female SD rats. No significant differences (p > 0.05) were found in the hematological properties or organ weights between the male and female SD rats. In the teratogenicity test, no toxicological signs were observed in either Wister pregnant rats or fetuses. The no-observed-adverse-effect level of CCSKO was determined to be more than 4 mL/kg body weight. These results suggested that CCSKO may be an excellent edible oil with high oral safety. Full article