Over the past two decades various concepts for the supply of lipids in parenteral and enteral nutrition have been developed. Traditionally, the nutritional dietary management typically includes physical mixtures of medium chain and long-chain triglycerides. Recently, chemically defined structured lipids have been developed that combine the advantages of conventional fats with those of special purposes. The first structured lipids were produced by mixing pure medium-chain triglycerides and long-chain triglycerides, allowing hydrolysis to free fatty acids, followed by random transesterification of the fatty acids into mixed triglyceride molecules. This results in a triglyceride containing combinations of short-, medium-, and long-chain fatty acids on a single glycerol backbone. These have unique chemical, physical, and/or physiological properties which differ from simply blending mixtures from the starting fats. By use of 1,3-specific or 2-specific lipases it is now possible to synthesize 1,3-specific or 2-specific triglycerides containing short- and/or medium-chain acids. For instance, incorporation of linoleic, arachidonic, or eicosapentaenoic acid at the sn-2 position is being evaluated for the specific objective of modulating membrane fatty acid composition and essential fatty acid absorption in models of cancer, burns, and immune dysfunction. This contribution reviews the current status of experimental and clinical studies of chemically defined structured lipid-based fat emulsions, with emphasis on their therapeutic potential for nutritional support in hospitalized patients.