156 References: 1. Kenler AS, et al. Ann Surg. 1996;223(3):316-333. 2. McKenna MC, et al. J Pediatr Gastroenterol Nutr. 1985;4(1):45-51. 3. Tso P, et al. Am J Physiol. 1995;268(4, pt 1): G568-G577. 4. Tso P, et al. Am J Physiol. 1999;277(2, pt 1):G333-G340. 5. Tso P, et al. J Nutr. 2001;131(8):2157-2163. 6. DeMichele SJ, et al. Metabolism. 1988;37(8):787-795. 7. DeMichele SJ, et al. Am J Clin Nutr. 1989;50(6):1295-1302. 8. Swenson ES, et al. Metabolism. 1991;40(5):484-490. 9. Teo TC, et al. Ann Surg. 1989;210(1):100-107. HOW ARE STRUCTURED LIPIDS MADE? STEP 1 A T T ACHED STEP 2 DE T ACH STEP 3 RANDOM REJOIN glycerol MCFA MCFA MCFA L C F A L C F A LCFA glycerol MCFA MCFA MCFA L C F A L C F A LCFA glycerol glycerol LCFA MCFA LCFA MCFA MCFA LCFA glycerol glycerol • Next-generation fats • Well-absorbed 1 and tolerated 1,2 • Compared with a simple physical mixture of MCT and LCT oils, preclinical studies show structured lipids: – Are better absorbed 3,4 – Enhance absorption of fat-soluble vitamins and antioxidants 5 – Help reduce muscle catabolism and improve nitrogen balance during metabolic stress 6-9 – Are rapidly hydrolyzed and provide increased delivery of fatty acids to systemic circulation 4 STEP 1 Medium- and long-chain fatty acids (MCFA and LCFA) are each attached to a glycerol backbone. STEP 2 Enzymes and chemical processes (de-esterification) detach the fatty acids from their glycerol backbone. STEP 3 These fatty acids are then randomly rejoined (re-esterification) to create lipids containing MCFA and LCFA on the same glycerol backbone.