Medium-chain fatty acids in nutritional therapy: A review

Authors

  • Izzati Nur Zulkanain Institute of Medical and Molecular Biotechnology, Universiti Teknologi MARA, Cawangan Selangor, 47000 Sg. Buloh, Malaysia
  • Sharaniza Ab-Rahim Dept. of Biochemistry and Molecular Medicine, Faculty of Medicine, Universiti Teknologi MARA, Cawangan Selangor, 47000 Sg. Buloh, Malaysia https://orcid.org/0000-0003-4502-3559
  • Siti Nazrina Camalxaman Centre of Medical Laboratory Technology, Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Selangor, 42300 Bandar Puncak Alam, Kuala Selangor, Malaysia https://orcid.org/0000-0002-0110-0746
  • Musalmah Mazlan Dept. of Biochemistry and Molecular Medicine, Faculty of Medicine, Universiti Teknologi MARA, Cawangan Selangor, 47000 Sg. Buloh, Malaysia https://orcid.org/0000-0002-7119-0433

DOI:

https://doi.org/10.11113/mjfas.v16n3.1610

Keywords:

medium chain fatty acid (MCFA), medium chain triglycerides (MCT), nutritional therapy, diabetes mellitus type 2, cardiovascular disease

Abstract

Medium-Chain Fatty Acids (MCFA) are saturated fats with aliphatic rings of 6-12 carbons. It is widely accepted that the metabolism of MCFA induces ketogenesis in the liver. Ketone bodies have been suggested to produce larger amounts of energy compared to glucose. Its benefit in providing an alternative source of energy has been as one of the strategies to prevent disease development especially those diseases that are associated with glucose metabolism or mitochondrial dysfunction. The current review highlights the nutritional impacts of MCFA and its utilization in disease therapy.

Author Biographies

Izzati Nur Zulkanain, Institute of Medical and Molecular Biotechnology, Universiti Teknologi MARA, Cawangan Selangor, 47000 Sg. Buloh, Malaysia

Institute of Medical and Molecular Biotechnology

Sharaniza Ab-Rahim, Dept. of Biochemistry and Molecular Medicine, Faculty of Medicine, Universiti Teknologi MARA, Cawangan Selangor, 47000 Sg. Buloh, Malaysia

Dept. of Biochemistry and Molecular Medicine, Senior Lecturer

Siti Nazrina Camalxaman, Centre of Medical Laboratory Technology, Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Selangor, 42300 Bandar Puncak Alam, Kuala Selangor, Malaysia

Centre of Medical Laboratory Technology, Lecturer

Musalmah Mazlan, Dept. of Biochemistry and Molecular Medicine, Faculty of Medicine, Universiti Teknologi MARA, Cawangan Selangor, 47000 Sg. Buloh, Malaysia

Dept. of Biochemistry and Molecular Medicine, Professor

References

A. Turpeinen and P. Merimaa, "Functional fats and spreads," Functional Foods (Second edition): Elsevier, 2011, pp. 383-400.

A. Codex, "Standard for named vegetable oils codex stan 210-1999," Codex Alimentarius, pp. 1-13, 1999.

M. V. Reddy, S. Hayashi, D. Choi, H. Cho, and Y.-C. Chang, "Short chain and medium chain fatty acids production using food waste under non-augmented and bio-augmented conditions," Journal of Cleaner Production, vol. 176, pp. 645-653, 2018.

C. R. Parrish, "The use of medium-chain triglycerides in gastrointestinal disorders," Nutrition Issues in Gastroenterology, vol. 160, no. February, pp. 20-28, 2017.

R. Li, J. Ma, K. Yu, and L. Wang, "Dietary or enteral medium-chain triglyceride usage in a Chinese general hospital," Asia Pacific Journal of Clinical Nutrition, vol. 24, no. 3, pp. 387-93, 2015.

R. D. Carol Rees Parrish, "When Chyle leaks: Nutrition management options," Practical Gastroenterology, 2004.

J. Zentek, S. Buchheit-Renko, F. Ferrara, W. Vahjen, A. G. Van Kessel, and R. Pieper, "Nutritional and physiological role of medium-chain triglycerides and medium-chain fatty acids in piglets," Animal Health Research Reviews, vol. 12, no. 1, pp. 83-93, Jun 2011.

B. Baltić, M. Starčević, J. Đorđević, B. Mrdović, and R. Marković, "Importance of medium chain fatty acids in animal nutrition," IOP Conference Series: Earth and Environmental Science, vol. 85, 2017.

B. Marten, M. Pfeuffer, and J. Schrezenmeir, "Medium-chain triglycerides," International Dairy Journal, vol. 16, no. 11, pp. 1374-1382, 2006.

B. Bloom, I. L. Chaikoff, and W. O. Reinhardt, "Intestinal lymph as pathway for transport of absorbed fatty acids of different chain lengths," American Journal of Physiology-Legacy Content, vol. 166, no. 2, pp. 451-455, 1951.

E. Lei, K. Vacy, and W. C. Boon, "Fatty acids and their therapeutic potential in neurological disorders," Neurochemistry International, vol. 95, pp. 75-84, 2016.

R. L. Veech, "The therapeutic implications of ketone bodies: The effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism," Prostaglandins, Leukotrienes and Essential Fatty Acids, vol. 70, no. 3, pp. 309-319, 2004.

K. Sato, Y. Kashiwaya, C. A. Keon, N. Tsuchiya, M. T. King, G. K. Radda, B. Chance, K. Clarke, R. L. Veech., "Insulin, ketone bodies, and mitochondrial energy transduction," FASEB journal : official publication of the Federation of American Societies for Experimental Biology, vol. 9, no. 8, pp. 651-8, 1995.

Y. Kashiwaya, K. Sato, N. Tsuchiya, S. Thomas, D. A. Fell, R. L. Veech, and J. V. Passonneau "Control of glucose utilization in working perfused rat heart," The Journal of Biological Chemistry, vol. 269, no. 41, pp. 25502-14, 1994.

J. R. Williamson, E. T. Browning, R. Scholz, R. A. Kreisberg, and I. B. Fritz, "Inhibition of fatty acid stimulation of gluconeogenesis by (+)-decanoylcarnitine in perfused rat liver," Diabetes, vol. 17, no. 4, pp. 194-208, 1968.

H. Nagasaka, K.-I. Hirano, T. Yorifuji, H. Komatsu, T. Takatani, I. Morioka, S. Hirayama, and T. Miida, "Treatment with medium chain fatty acids milk of CD36-deficient preschool children," Nutrition, vol. 50, pp. 45-48, 2018.

M.-P. St-Onge, A. Bosarge, L. L. T. Goree, and B. Darnell, "Medium chain triglyceride oil consumption as part of a weight loss diet does not lead to an adverse metabolic profile when compared to olive oil," Journal of the American College of Nutrition, vol. 27, no. 5, pp. 547-52, 2008.

M. M. Lavau and S. A. Hashim, "Effect of medium chain triglyceride on lipogenesis and body fat in the rat," The Journal of Nutrition, vol. 108, no. 4, pp. 613-620, 1978.

A. Geliebter, N. Torbay, E. F. Bracco, S. A. Hashim, and T. B. Van Itallie, "Overfeeding with medium-chain triglyceride diet results in diminished deposition of fat," The American Journal of Clinical Nutrition, vol. 37, no. 1, pp. 1-4, 1983.

L. Scalfi, A. Coltorti, and F. Contaldo, "Postprandial thermogenesis in lean and obese subjects after meals supplemented with medium-chain and long-chain triglycerides," The American Journal of Clinical Nutrition, vol. 53, no. 5, pp. 1130-1133, 1991.

A. G. Dulloo, M. Fathi, N. Mensi, and L. Girardier, "Twenty-four-hour energy expenditure and urinary catecholamines of humans consuming low-to-moderate amounts of medium-chain triglycerides: a dose-response study in a human respiratory chamber," European journal of clinical nutrition, vol. 50, no. 3, pp. 152-8, 1996.

K. Mumme and W. Stonehouse, "Effects of Medium-chain triglycerides on weight loss and body composition: A Meta-analysis of randomized controlled trials," Journal of the Academy of Nutrition and Dietetics, vol. 115, no. 2, pp. 249-263, 2015.

M. P. St-Onge and P. J. H. Jones, "Greater rise in fat oxidation with medium-chain triglyceride consumption relative to long-chain triglyceride is associated with lower initial body weight and greater loss of subcutaneous adipose tissue," International Journal of Obesity, vol. 27, no. 12, pp. 1565-1571, 2003.

S. D. Poppitt, C. M. Strik, A. K. H. MacGibbon, B. H. McArdle, S. C. Budgett, and A. T. McGill, "Fatty acid chain length, postprandial satiety and food intake in lean men," Physiology & Behavior, vol. 101, no. 1, pp. 161-167, 2010.

H. Mu and T. Porsgaard, "The metabolism of structured triacylglycerols," Progress in Lipid Research, vol. 44, no. 6, pp. 430-448, 2005.

R. T. Woodyatt, "Objects and method of diet adjustment in diabetes," Archives of Internal Medicine, vol. 28, no. 2, pp. 125-125, 1921.

M. G. Peterman, "The ketogenic diet in epilepsy," JAMA: The Journal of the American Medical Association, vol. 84, no. 26, pp. 1979-1979, 1925.

M. Gracey, V. Burke, and C. M. Anderson, "Medium chain triglycerides in paediatric practice," Review Article Archives of Disease in Childhood, pp. 445-445, 1970.

M. Koithan and J. Devika, "New Approaches to nutritional therapy," The journal for nurse practitioners : JNP, vol. 6, no. 10, pp. 805-806, 2010.

T. Hung, J. L. Sievenpiper, A. Marchie, C. W. C. Kendall, and D. J. A. Jenkins, "Fat versus carbohydrate in insulin resistance, obesity, diabetes and cardiovascular disease," Current Opinion in Clinical Nutrition and Metabolic Care, vol. 6, no. 2, pp. 165-76, 2003.

U. Bradley, M. Spence, C. H. Courtney, M. C. McKinley, C. N. Ennis, D. R. McCance, J. McEneny, P. M. Bell, I. S. Young, S. J. Hunter, "Low-fat versus low-carbohydrate weight reduction diets: effects on weight loss, insulin resistance, and cardiovascular risk: a randomized control trial," Diabetes, vol. 58, no. 12, pp. 2741-8, 2009.

J. R. Han, B. Deng, J. Sun, C. G. Chen, B. E. Corkey, J. L. Kirkland, J. Ma, W. Guo, "Effects of dietary medium-chain triglyceride on weight loss and insulin sensitivity in a group of moderately overweight free-living type 2 diabetic Chinese subjects," Metabolism, vol. 56, no. 7, pp. 985-991, 2007.

B. Deng, J. Sun, W. H. Ling, B. Y. Tan, and J. Ma, "Effects of medium chain triglyceride on insulin resistance in type 2 diabetes mellitus," pp. 148-152, 2009.

J. Hoeks, M. Mensink, M. K. C. Hesselink, K. Ekroos, and P. Schrauwen, "Long- and medium-chain fatty acids induce insulin resistance to a similar extent in humans despite marked differences in muscle fat accumulation," The Journal of Clinical Endocrinology & Metabolism, vol. 97, no. 1, pp. 208-216, 2012.

S. Airhart, W. T. Cade, H. Jiang, A. R. Coggan, S. B. Racette, K. Korenblat, C. A. Spearie, et al., "A Diet Rich in Medium-Chain Fatty Acids Improves Systolic Function and Alters the Lipidomic Profile in Patients With Type 2 Diabetes: A Pilot Study," The Journal of clinical endocrinology and metabolism, vol. 101, no. 2, pp. 504-12, 2016.

Z. S. Khachaturian, "Diagnosis of Alzheimer's disease," Archives of Neurology, vol. 42, no. 11, pp. 1097-105, 1985.

S. S. Mirra A. Heyman, D. McKeel, S. M. Sumi, B. J. Crain, L. M. Brownlee, F. S. Vogel, J. P. Hughes, G. V. Belle, L. Berg, "The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease," Neurology, vol. 41, no. 4, pp. 479-86, 1991.

R. A. Armstrong, "Plaques and tangles and the pathogenesis of Alzheimer's disease," Folia Neuropathologica, vol. 44, no. 1, pp. 1-11, 2006.

G. Šimić, M. B. Leko, S. Wray, C. Harrington, I. Delalle, N. J. Milošević, D. Bažadona et al., "Tau Protein Hyperphosphorylation and Aggregation in Alzheimer's Disease and Other Tauopathies, and Possible Neuroprotective Strategies," Biomolecules, vol. 6, no. 1, pp. 6-6, 2016.

A. Mietelska-Porowska, U. Wasik, M. Goras, A. Filipek, and G. Niewiadomska, "Tau protein modifications and interactions: their role in function and dysfunction," International Journal of Molecular Sciences, vol. 15, no. 3, pp. 4671-713, 2014.

E. Freemantle, H. M. Derry, R. Bornstein, R. S. Prakash, J. Peng, M. A. Belury, R. R. Andridge, "Omega-3 fatty acids, energy substrates, and brain function during aging," Prostaglandins, Leukotrienes and Essential Fatty Acids, vol. 75, no. 3, pp. 213-220, 2006.

S. T. Henderson, J. L. Vogel, L. J. Barr, F. Garvin, J. J. Jones, and L. C. Costantini, "Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: A randomized, double-blind, placebo-controlled, multicenter trial," Nutrition & Metabolism, vol. 6, pp. 31-31, 2009.

M. P. Lambert A. K. Barlow, B. A. Chromy, C. Edwards, R. Freed, M. Liosatos, T. E. Morgan, I. Rozovsky, B. Trommer, K. L. Viola, P. Wals, C. Zhang, C. E. Finch, G. A. Krafft, W. L. Klein, "Diffusible, nonfibrillar ligands derived from Abeta1-42 are potent central nervous system neurotoxins," Proceedings of the National Academy of Sciences of the United States of America, vol. 95, no. 11, pp. 6448-53, 1998.

R. H. Swerdlow, J. M. Burns, and S. M. Khan, "The Alzheimer's disease mitochondrial cascade hypothesis," Journal of Alzheimer's Disease, vol. 20, no. s2, pp. S265-S279, 2010.

J. Nathan and S. Panjwani, "Use Of medium chain triglycerides (mct) in Alzheimer’s disease (AD): Pilot trial," Alzheimer's & Dementia, vol. 13, no. 7, pp. P611-P611, 2017.

T. Ohnuma, A. Toda, A. Kimoto, Y. Takebayashi, R. Higashiyama, Y. Tagata, M. Ito, T. Ota, N. Shibata, H. Arai, "Benefits of use, and tolerance of, medium-chain triglyceride medical food in the management of Japanese patients with Alzheimer's disease: a prospective, open-label pilot study," Clinical interventions in aging, vol. 11, pp. 29-36, 2016.

M. Ota, J. Matsuo, I. Ishida, H. Takano, Y. Yokoi, H. Hori et al., "Effects of a medium-chain triglyceride-based ketogenic formula on cognitive function in patients with mild-to-moderate Alzheimer’s disease," Neuroscience Letters, vol. 690, pp. 232-236, 2019.

G. B. D. Mortality and C. Causes of death, "Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: A systematic analysis for the Global burden of disease study 2013," The Lancet, vol. 385, no. 9963, pp. 117-171, 2015.

B. J. Brehm, R. J. Seeley, S. R. Daniels, and D. A. D’Alessio, "A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women," The Journal of Clinical Endocrinology & Metabolism, vol. 88, no. 4, pp. 1617-1623, 2003.

I. Shai, D. Schwarzfuchs, Y. Henkin, D. R. Shahar, S. Witkow, I. Greenberg et al., "Weight loss with a low-carbohydrate, mediterranean, or low-fat diet," New England Journal of Medicine, vol. 359, no. 3, pp. 229-241, 2008.

J. S. Volek, S. D. Phinney, C. E. Forsythe, E. E. Quann, R. J. Wood, M. J. Puglisi et al., "Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet," Lipids, vol. 44, no. 4, pp. 297-309, 2009.

M. J. Sharman, W. J. Kraemer, D.M. Love, N. G. Avery, A. L. Gómez, T. P. Scheett, J. S. Vole "A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men," The Journal of Nutrition, vol. 132, no. 7, pp. 1879-1885, 2002.

J. S. Volek, M. J. Sharman, and C. E. Forsythe, "Modification of Lipoproteins by Very low-carbohydrate diets," The Journal of Nutrition, vol. 135, no. 6, pp. 1339-1342, 2005.

N. Baba, E. F. Bracco, and S. A. Hashim, "Enhanced thermogenesis and diminished deposition of fat in response to overfeeding with diet containing medium chain triglyceride," The American Journal of Clinical Nutrition, vol. 35, no. 4, pp. 678-682, 1982.

V. K. R. Kondreddy, M. Anikisetty, and K. A. Naidu, "Medium-chain triglycerides and monounsaturated fatty acids potentiate the beneficial effects of fish oil on selected cardiovascular risk factors in rats," The Journal of Nutritional Biochemistry, vol. 28, pp. 91-102, 2016.

J. L. Eriksen, Z. Wszolek, and L. Petrucelli, "Molecular pathogenesis of parkinson disease," Archives of Neurology, vol. 62, no. 3, pp. 353-353, 2005.

E. A. Lock, J. Zhang, and H. Checkoway, "Solvents and Parkinson disease: A systematic review of toxicological and epidemiological evidence," Toxicology and Applied Pharmacology, vol. 266, no. 3, pp. 345-55, 2013.

X. Yang and B. Cheng, "Neuroprotective and anti-inflammatory activities of ketogenic diet on MPTP-induced neurotoxicity," Journal of Molecular Neuroscience, vol. 42, no. 2, pp. 145-153, 2010.

S. Shaafi, S. Najmi, H. Aliasgharpour, J. Mahmoudi, S. S.-Etemad, M. Farhoudi ,N. Baniasadi, "The efficacy of the ketogenic diet on motor functions in Parkinson's disease: A rat model," Iranian Journal of Neurology, vol. 15, no. 2, pp. 63-9, 2016.

M. Gasior, M. A. Rogawski, and A. L. Hartman, "Neuroprotective and disease-modifying effects of the ketogenic diet," Behavioural Pharmacology, vol. 17, no. 5-6, pp. 431-9, 2006.

L. M. L. de Lau, M. Bornebroek, J. C. M. Witteman, A. Hofman, P. J. Koudstaal, and M. M. B. Breteler, "Dietary fatty acids and the risk of Parkinson disease: The Rotterdam Study," Neurology, vol. 64, no. 12, pp. 2040-2045, 2005.

L. K. Mischley, R. C. Lau, R. D. Bennett, "Role of diet and nutritional supplements in Parkinson’s disease progression," Oxidative Medicine and Cellular Longevity, vol. 2017, pp. 1-9, 2017.

K. N. Prasad, W. C. Cole, and B. Kumar, "Multiple antioxidants in the prevention and treatment of Parkinson's disease," Journal of the American College of Nutrition, vol. 18, no. 5, pp. 413-23, 1999.

A. C. Famurewa, C. A. Ekeleme-Egedigwe, S. C. Nwali, N. N. Agbo, J. N. Obi, and G. C. Ezechukwu, "Dietary Supplementation with virgin coconut oil improves lipid profile and hepatic antioxidant status and has potential benefits on cardiovascular risk indices in normal rats," Journal of Dietary Supplements, vol. 15, no. 3, pp. 330-342, 2018.

P. R. Huttenlocher, A. J. Wilbourn, and J. M. Signore, "Medium-chain triglycerides as a therapy for intractable childhood epilepsy," Neurology, vol. 21, no. 11, pp. 1097-103, 1971.

R. H. Schwartz, J. Eaton, B. D. Bower, and A. Aynsley-Green, "Ketogenic diets in the treatment of epilepsy: short-term clinical effects," Developmental medicine and child neurology, vol. 31, no. 2, pp. 145-51, 1989.

M. S. Chaambers and R. J. Jacob, "How carcinogens cause cancer," Texas dental journal, vol. 111, no. 6, pp. 13-9, 1994.

R. A. Gatenby and R. J. Gillies, "Why do cancers have high aerobic glycolysis?," Nature Reviews Cancer, vol. 4, no. 11, pp. 891-899, 2004.

S. A. Frank, Carcinogens. Princeton University Press, 2007.

M. G. Vander Heiden, D. R. Plas, J. C. Rathmell, C. J. Fox, M. H. Harris, and C. B. Thompson, "Growth factors can influence cell growth and survival through effects on glucose metabolism," Molecular and Cellular Biology, vol. 21, no. 17, pp. 5899-912, 2001.

A. Fadaka, B. Ajiboye, O. Ojo, O. Adewale, I. Olayide, and R. Emuowhochere, "Biology of glucose metabolization in cancer cells," Journal of Oncological Sciences, vol. 3, no. 2, pp. 45-51, 2017.

S.-Y. Kim, "Cancer energy metabolism: Shutting power off cancer factory," Biomolecules & Therapeutics, vol. 26, no. 1, pp. 39-44, 2018.

O. Warburg, "On the origin of cancer cells," Science (New York, N.Y.), vol. 123, no. 3191, pp. 309-14, 1956.

M. V. Liberti and J. W. Locasale, "The Warburg effect: How does it benefit cancer cells?," Trends in Biochemical Sciences, vol. 41, no. 3, pp. 211-218, 2016.

T. Anne, "How cancer cells fuel their growth | MIT News," ed, 2016.

Institute National Cancer, "Another Cancer Cell Energy Source - National Cancer Institute," ed, 2016.

Y. Chen, N. G., Mahieu, X, Huang, M, Singh, P., A. Crawford, S. L. Johnson, R. W. Gross, J. Schaefer, G. J. Patti, "Lactate metabolism is associated with mammalian mitochondria," Nature chemical biology, vol. 12, no. 11, pp. 937-943, 2016.

A. Narayanan, S. A. Baskaran, M. A. R. Amalaradjou, and K. Venkitanarayanan, "Anticarcinogenic properties of medium chain fatty acids on human colorectal, skin and breast cancer cells in vitro," International Journal of Molecular Sciences, vol. 16, no. 3, pp. 5014-27, 2015.

Eur, A. D. Düregger, R. Ramoner, J. Pante, M. Steinmair, and H. Klocker, "Differential metabolic effects of medium-chain triglycerides and omega-3 fatty acids in benign and malignant prostate cells - evidence for a ketogenic diet as adjuvant therapy for prostate cancer," European Urology Supplements, vol. 13, no. 1, p. e305, 2014.

J. K. Fauser, G. M. Matthews, A. G. Cummins, and G. S. Howarth, "Induction of apoptosis by the medium-chain length fatty acid lauric acid in colon cancer cells due to induction of oxidative stress," Chemotherapy, vol. 59, no. 3, pp. 214-24, 2013.

Y. Kadochi, S. Mori, R. F. Tani, Y. Luo, Y. Nishiguchi, S. Kishi, K. Fujii, H. Ohmori, H. Kuniyasu, "Remodeling of energy metabolism by a ketone body and medium-chain fatty acid suppressed the proliferation of CT26 mouse colon cancer cells," Oncology letters, vol. 14, no. 1, pp. 673-680, 2017.

Y. Chen, H. Zhang, H. J. Zhou, W. Ji, and W. Min, "Mitochondrial Redox Signaling and Tumor Progression," Cancers, vol. 8, no. 4, 2016.

M. Buzzai, D. E. Bauer, R. G. Jones et al., "The glucose dependence of Akt-transformed cells can be reversed by pharmacologic activation of fatty acid β-oxidation," Oncogene, vol. 24, no. 26, pp. 4165-4173, 2005.

M. Schmidt, N. Pfetzer, M. Schwab, I. Strauss, and U. Kämmerer, "Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot trial," Nutrition & Metabolism, vol. 8, no. 1, pp. 54-54, 2011.

A. I. R. Maas, N. Stocchetti, and R. Bullock, "Moderate and severe traumatic brain injury in adults," The Lancet Neurology, vol. 7, no. 8, pp. 728-741, 2008.

K. E. Saatman, A.C. Duhaime, R. Bullock, A. I. R. Maas, A. Valadka, G. T. Manley, "Classification of traumatic brain injury for targeted therapies," Journal of Neurotrauma, vol. 25, no. 7, pp. 719-38, 2008.

A. Sauaia, F. A. Moore, E. E. Moore, K. S. Moser, R. Brennan, R. A. Read, P. T. Pon, "Epidemiology of trauma deaths: A reassessment," The Journal of Trauma, vol. 38, no. 2, pp. 185-93, 1995.

T. Murthy, P. Bhatia, K. Sandhu, T. Prabhakar, and R. L. Gogna, "Secondary brain injury: Prevention and intensive care management," The Indian Journal of Neurotrauma, vol. 2, no. 1, pp. 7-12, 2005.

E. Park, J. D. Bell, and A. J. Baker, "Traumatic brain injury: can the consequences be stopped?," Canadian Medical Association Journal, vol. 178, no. 9, pp. 1163-70, 2008.

C. A. Walleck, "Preventing secondary brain injury," AACN Clinical Issues in Critical Care Nursing, vol. 3, no. 1, pp. 19-30, 1992.

H. Ito, I. Kanno, M. Ibaraki, J. Hatazawa, and S. Miura, "Changes in Human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography," Journal of Cerebral Blood Flow & Metabolism, vol. 23, no. 6, pp. 665-670, 2003.

J. Lok, W. Leung, S. Murphy, W. Butler, N. Noviski, and E. H. Lo, "Intracranial hemorrhage: mechanisms of secondary brain injury," Acta Neurochirurgica. Supplement, vol. 111, pp. 63-9, 2011.

M. Maalouf, J. M. Rho, and M. P. Mattson, "The neuroprotective properties of calorie restriction, the ketogenic diet, and ketone bodies," Brain Research Reviews, vol. 59, no. 2, pp. 293-315, 2009.

M. Suzuki, M. Suzuki, Y. Kitmura, S. Mori, "Beta-hydroxybutyrate, a cerebral function improving agent, protects rat brain against ischemic damage caused by permanent and transient focal cerebral ischemia," Japanese Journal of Pharmacology, vol. 89, no. 1, pp. 36-43, 2002.

L. M. Davis, J. R. Pauly, R. D. Readnower, J. M. Rho, and P. G. Sullivan, "Fasting is neuroprotective following traumatic brain injury," Journal of Neuroscience Research, vol. 86, no. 8, pp. 1812-1822, 2008.

H. White and B. Venkatesh, "Clinical review: Ketones and brain injury," Critical Care (London, England), vol. 15, no. 2, pp. 219-219, 2011.

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15-06-2020