RESEARCH Effects of Medium-Chain Triglycerides on Weight Loss and Body Composition: A Meta-Analysis of Randomized Controlled Trials Karen Mumme, PGDipSc Welma Stonehouse, PhD Mumme K, Stonehouse W. J Acad Nutr Diet. 2015;115(2).

Inclusion Criteria Exclusion Criteria RESEARCH Key criteria used to select studies for a meta-analysis that measured the effects of medium-chain triglycerides on weight loss and body composition Inclusion Criteria Exclusion Criteria Randomized controlled experimental design, either parallel or cross-over published in peer reviewed journal before 31 March 2014 Study duration > 3 weeks Participants were healthy adults ≥ 18 years Ad libitum, weight maintaining and reduced calorie diets were included Interventions were to include C8:0 and C10:0 fatty acids with a control containing a longer chain fatty acids Any exercise intervention included with dietary intervention No language restrictions Mumme K, Stonehouse W. J Acad Nutr Diet. 2015;115(2).

Data extraction and synthesis RESEARCH Key quality appraisal, data extraction and synthesis methods for a meta-analysis that measured the effects of medium-chain triglycerides (MCT) on weight loss and body composition Quality appraisal A bias assessment was performed following the Cochrane risk of bias assessmenta to assess the validity of studies Data extraction and synthesis Estimated mean (95% CI) differences in body weight and fat mass between MCT and control groups were calculated from mean ± SD changes. Where the standard deviation was imputed a sensitivity analysis was undertaken to assess the influence of imputed data Sub group analyses were conducted to determine whether sex, baseline body weight status, length of intervention or dosage affected the outcomes. Additionally a post hoc analysis was done for commercial bias aHiggins J, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 Oxford, England: The Cochrane Collaboration; 2011 Mumme K, Stonehouse W. J Acad Nutr Diet. 2015;115(2).

Figure 1. Quality assessment of studies RESEARCH Figure 1. Quality assessment of studies The meta-analysis consisted of 13 studies containing 749 healthy adult participants Mumme K, Stonehouse W. J Acad Nutr Diet. 2015;115(2).

RESEARCH Figure 2. Forest plot showing changes in body weight (in kilograms) in trials comparing dietary medium-chain triglycerides (MCT) with a longer-chain triglyceride (control) shows a favorable effect of MCT intervention on body weight . *Oleic acid as control **Myristic acid as control. #Body mass index <23. ##Body mass ≥23. CI=confidence interval. IV=inverse variance. SD=standard deviation Mumme K, Stonehouse W. J Acad Nutr Diet. 2015;115(2).

Similar small positive effects were also seen in RESEARCH Further results from a meta-analysis that measured the effects of medium-chain triglycerides on weight loss and body composition Similar small positive effects were also seen in waist circumference (-1.46 cm [95%CI -2.04 to -0.87 cm], P<0.001) hip circumference (-0.79 cm [95%CI -1.27 to -0.30 cm], P=0.002) total body fat (standard mean difference -0.39 [95%CI -0.57 to -0.22], P<0.001 total subcutaneous fat (standard mean difference -0.46 [95%CI -0.64 to -0.27], P<0.001 visceral fat (standard mean difference -0.55 [95%CI -0.75 to -0.34], P<0.001 Publication bias was not evident in body weight (Egger P=0.35) and total body fat (P=0.05) and not able to be measured in other outcomes due to low study numbers Sub-group analysis resulted in greater weight loss where study duration ≥ 12 weeks (P=0.004) doses <8% energy compared with >16% energy (P=0.03) study showed commercial bias (P=0.001) Mumme K, Stonehouse W. J Acad Nutr Diet. 2015;115(2).

inadequate reporting makes assessment of bias in each study difficult RESEARCH Conclusions from a meta-analysis that measured the effects of medium-chain triglycerides on weight loss and body composition Replacement of long-chain triglycerides with medium-chain triglycerides in the diet, could potentially induce modest reductions in body mass and composition. However, inadequate reporting makes assessment of bias in each study difficult although heterogeneity was absent (except body weight was moderate), study designs varied with regard to design, dose, duration and level and control of energy intake 6/13 studies contained commercial bias Mumme K, Stonehouse W. J Acad Nutr Diet. 2015;115(2).

Further research is required Future direction from a meta-analysis that measured the effects of medium-chain triglycerides on weight loss and body composition Further research is required by independent research groups using large, robustly designed studies of sufficient duration (at least 12 weeks) with different MCT doses in different food matrixes with different populations with different body weight status groups (normal weight vs overweight/obese) by sex and age groups also capturing pre- and postmenopausal women on the effect of MCT on the fat:lean mass particularly in weight loss studies and older adults on the long-term safety of MCT-enriched foods Mumme K, Stonehouse W. J Acad Nutr Diet. 2015;115(2).