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. 1970 Aug;45(242):445–452. doi: 10.1136/adc.45.242.445

Medium Chain Triglycerides in Paediatric Practice

Michael Gracey, Valerie Burke, Charlotte M Anderson
PMCID: PMC1647651  PMID: 4918706

Abstract

Medium chain triglycerides (MCT) bypass the steps necessary for the absorption of long chain fats (LCT), and so have theoretical grounds for their use in various disease states, particularly malabsorptive disorders. In childhood, MCT have particular advantages since they allow restriction of dietary long chain fats without limiting the intake of protein necessary for growth while providing adequate calories.

In malabsorptive states, MCT have been used mostly in cystic fibrosis, where they may reduce steatorrhoea. However, the long-term growth patterns of these children are dependent on the extent and severity of their chest disease. MCT may be a useful source of calories for those with anorexia due to infection or liver disease and in babies recovering from meconium ileus. The decrease in offensive stools, flatus, and abdominal discomfort improves well-being and social acceptability which is important for many schoolchildren and adolescents. Rectal prolapse may be helped.

Where there is loss of the small intestinal absorptive surface, particularly after massive small bowel resection, MCT can help to maintain weight and nutrition. They may also be a useful supplementary nutritional measure in patients severely affected with coeliac disease while awaiting response to a gluten-free diet, and in patients with regional enteritis.

In children with liver disease, MCT provide a ready source of calories while avoiding the loss of fat in their stools. Infants with neonatal hepatitis or biliary atresia remain well nourished, and some older children with liver disease grow more rapidly and have fewer and less offensive stools and less abdominal discomfort.

Where an abnormal number of faecal organisms colonize the small intestine (`contaminated small bowel syndrome' or `blind loop syndrome') intraluminal bile salts become deconjugated and cause steatorrhoea. A combination of antibiotic and surgical treatment is usually indicated, but MCT can be used to improve nutrition before operation and may be indicated for associated conditions, such as massive intestinal resection.

MCT have also been helpful in patients with defective chylomicron formation due to a-β-lipoproteinaemia.

In the congenital and less commonly encountered acquired lymphatic disorders in childhood, MCT have given encouraging results. This group includes patients with gross protein and fat loss due to intestinal lymphangiectasia and others with lymphatic anomalies at other sites.

Hyperchylomicronaemia (familial fat-induced hypertriglyceridaemia) responds well to dietary treatment with MCT.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ASTALDI G., STROSSELLI E. Peroral biopsy of the intestinal mucosa in hepatic cirrhosis. Am J Dig Dis. 1960 Jul;5:603–612. doi: 10.1007/BF02290193. [DOI] [PubMed] [Google Scholar]
  2. Anderson C. M. Intestinal malabsorption in childhood. Arch Dis Child. 1966 Dec;41(220):571–596. doi: 10.1136/adc.41.220.571. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Austad W. I., Lack L., Tyor M. P. Importance of bile acids and of an intact distal small intestine for fat absorption. Gastroenterology. 1967 Apr;52(4):638–646. [PubMed] [Google Scholar]
  4. BLOOM B., CHAIKOFF I. L., REINHARDT Intestinal lymph as pathway for transport of absorbed fatty acids of different chain lengths. Am J Physiol. 1951 Aug;166(2):451–455. doi: 10.1152/ajplegacy.1951.166.2.451. [DOI] [PubMed] [Google Scholar]
  5. Blum M., Spritz N. The metabolism of intravenously injected isotopic cholic acid in Laennec's cirrhosis. J Clin Invest. 1966 Feb;45(2):187–193. doi: 10.1172/JCI105331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Burke V., Colebatch J. H., Anderson C. M., Simons M. J. Association of pancreatic insufficiency and chronic neutropenia in childhood. Arch Dis Child. 1967 Apr;42(222):147–157. doi: 10.1136/adc.42.222.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Burke V., Danks D. M. Medium-chain triglyceride diet: its use in treatment of liver disease. Br Med J. 1966 Oct 29;2(5521):1050–1051. doi: 10.1136/bmj.2.5521.1050. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. CANCIO M., MENENDEZ CORRADA R. ABSORPTION OF MEDIUM CHAIN TRIGLYCERIDES IN TROPICAL SPRUE. Proc Soc Exp Biol Med. 1964 Oct;117:182–185. doi: 10.3181/00379727-117-29530. [DOI] [PubMed] [Google Scholar]
  9. DAHL D. R., DAHL N., SAMSON F. E., Jr A study on the narcotic action of the short chain fatty acids. J Clin Invest. 1956 Nov;35(11):1291–1298. doi: 10.1172/JCI103384. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Dyer N. H., Dawson A. M. Malabsorption. Br Med J. 1968 Apr 27;2(5599):225–227. doi: 10.1136/bmj.2.5599.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. FREYE H. B., KURTZ S. M., SPOCK A., CAPP M. P. LIGHT AND ELECTRON MICROSCOPIC EXAMINATION OF THE SMALL BOWEL OF CHILDREN WITH CYSTIC FIBROSIS. J Pediatr. 1964 Apr;64:575–579. doi: 10.1016/s0022-3476(64)80351-6. [DOI] [PubMed] [Google Scholar]
  12. Furman R. H., Howard R. P., Brusco O. J., Alaupovic P. Effects of medium chain length triglyceride (MCT) on serum lipids and lipoproteins in familial hyperchylomicronemia (dietary fat-induced lipemia) and dietary carbohydrate-accentuated lipemia. J Lab Clin Med. 1965 Dec;66(6):912–926. [PubMed] [Google Scholar]
  13. Gracey M., Anderson C. M. Cystic fibrosis of the pancreas in adolescence and adulthood. Australas Ann Med. 1969 May;18(2):91–101. doi: 10.1111/imj.1969.18.2.91. [DOI] [PubMed] [Google Scholar]
  14. Gracey M., Burke V., Anderson C. M. Assessment of medium-chain triglyceride feeding in infants with cystic fibrosis. Arch Dis Child. 1969 Jun;44(235):401–403. doi: 10.1136/adc.44.235.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Greenberger N. J., Ruppert R. D., Tzagournis M. Use of medium chain triglycerides in malabsorption. Ann Intern Med. 1967 Apr;66(4):727–734. doi: 10.7326/0003-4819-66-4-727. [DOI] [PubMed] [Google Scholar]
  16. HASHIM S. A., ARTEAGA A., VAN ITALLIE T. B. Effect of a saturated medium-chain triglyceride on serum-lipids in man. Lancet. 1960 May 21;1(7134):1105–1108. doi: 10.1016/s0140-6736(60)90986-7. [DOI] [PubMed] [Google Scholar]
  17. Harries J. T., Francis D. E. Temporary monosaccharide intolerance. Acta Paediatr Scand. 1968 Nov;57(6):505–511. doi: 10.1111/j.1651-2227.1968.tb06970.x. [DOI] [PubMed] [Google Scholar]
  18. Holt P. R. Medium chain triglycerides. A useful adjunct in nutritional therapy. Gastroenterology. 1967 Dec;53(6):961–966. [PubMed] [Google Scholar]
  19. ISSELBACHER K. J., SCHEIG R., PLOTKIN G. R., CAULFIELD J. B. CONGENITAL BETA-LIPOPROTEIN DEFICIENCY: AN HEREDITARY DISORDER INVOLVING A DEFECT IN THE ABSORPTION AND TRANSPORT OF LIPIDS. Medicine (Baltimore) 1964 May;43:347–361. [PubMed] [Google Scholar]
  20. Isselbacher K. J. Biochemical aspects of fat absorption. Gastroenterology. 1966 Jan;50(1):78–82. [PubMed] [Google Scholar]
  21. JEFFRIES G. H., CHAPMAN A., SLEISENGER M. H. LOW-FAT DIET IN INTESTINAL LYMPHANGIECTASIA. ITS EFFECT ON ALBUMIN METABOLISM. N Engl J Med. 1964 Apr 9;270:761–766. doi: 10.1056/NEJM196404092701503. [DOI] [PubMed] [Google Scholar]
  22. Krone C. L., Theodor E., Sleisenger M. H., Jeffries G. H. Studies on the pathogenesis of malabsorption. Lipid hydrolysis and micelle formation in the intestinal lumen. Medicine (Baltimore) 1968 Mar;47(2):89–106. doi: 10.1097/00005792-196803000-00001. [DOI] [PubMed] [Google Scholar]
  23. Kuo P. T., Huang N. N. The effect of medium chain triglyceride upon fat absorption and plasma lipid and depot fat of children with cystic fibrosis of the pancreas. J Clin Invest. 1965 Nov;44(11):1924–1933. doi: 10.1172/JCI105298. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Leyland F. C., Fosbrooke A. S., Lloyd J. K., Segall M. M., Tamir I., Tomkins R., Wolff O. H. Use of medium-chain triglyceride diets in children with malabsorption. Arch Dis Child. 1969 Apr;44(234):170–179. doi: 10.1136/adc.44.234.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lindberg T., Nordén A., Josefsson L. Intestinal dipeptidases. Dipeptidase activities in small intestinal biopsy specimens from a clinical material. Scand J Gastroenterol. 1968;3(2):177–182. doi: 10.3109/00365526809180119. [DOI] [PubMed] [Google Scholar]
  26. Linscheer W. G., Patterson J. F., Moore E. W., Clermont R. J., Robins S. J., Chalmers T. C. Medium and long chain fat absorption in patients with cirrhosis. J Clin Invest. 1966 Aug;45(8):1317–1325. doi: 10.1172/JCI105438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lloyd J. K. Disorders of the serum lipoproteins. II. Hyperlipoproteinaemic states. Arch Dis Child. 1968 Oct;43(231):505–515. doi: 10.1136/adc.43.231.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Losowsky M. S., Walker B. E. Liver disease and malabsorption. Gastroenterology. 1969 Mar;56(3):589–600. [PubMed] [Google Scholar]
  29. MARTINI G. A., PHEAR E. A., RUEBNER B., SHERLOCK S. The bacterial content of the small intestine in normal and cirrhotic subjects: relation to methionine toxicity. Clin Sci. 1957 Feb;16(1):35–51. [PubMed] [Google Scholar]
  30. MULLINS F., TALAMO R., DISANTAGNESE P. A. LATE INTESTINAL COMPLICATIONS OF CYSTIC FIBROSIS. JAMA. 1965 May 31;192:741–746. doi: 10.1001/jama.1965.03080220005001. [DOI] [PubMed] [Google Scholar]
  31. Mathan V. I., Joseph S., Baker S. J. Tropical sprue in children. A syndrome of idiopathic malabsorption. Gastroenterology. 1969 Mar;56(3):556–570. [PubMed] [Google Scholar]
  32. Norman A., Strandvik B., Zetterström R. Bile acid excretion and malabsorption in intrahepatic cholestasis of infancy ("neonatal hepatitis"). Acta Paediatr Scand. 1969 Jan;58(1):59–72. doi: 10.1111/j.1651-2227.1969.tb04330.x. [DOI] [PubMed] [Google Scholar]
  33. PINTER K. G., MCCRACKEN B. H., LAMAR C., Jr, GOLDSMITH G. A. FAT ABSORPTION STUDIES IN VARIOUS FORMS OF STEATORRHEA. Am J Clin Nutr. 1964 Nov;15:293–298. doi: 10.1093/ajcn/15.5.293. [DOI] [PubMed] [Google Scholar]
  34. PLAYOUST M. R., ISSELBACHER K. J. STUDIES ON THE INTESTINAL ABSORPTION AND INTRAMUCOSAL LIPOLYSIS OF A MEDIUM CHAIN TRIGLYCERIDE. J Clin Invest. 1964 May;43:878–885. doi: 10.1172/JCI104973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Pinter K. G., Hyman H., 3rd, Bolanos O. Fat and nitrogen balance with medium-chain triglycerides after massive intestinal resection. Am J Clin Nutr. 1969 Jan;22(1):14–20. doi: 10.1093/ajcn/22.1.14. [DOI] [PubMed] [Google Scholar]
  37. Poley J. R., Lesch P., Hitzig W. H., Prader A. Chylöser Ascites. Untersuchungen über den Eiweissstoffwechsel und über den Einfluss des Nahrungsfetts auf die Ascitesproduktion. Helv Paediatr Acta. 1967 Apr;22(1):81–109. [PubMed] [Google Scholar]
  38. Schizas A. A., Cremen J. A., Larson E., O'Brien R. Medium-chain triglycerides--use in food preparation. J Am Diet Assoc. 1967 Sep;51(3):228–232. [PubMed] [Google Scholar]
  39. Senior J. R. The place of medium chain triglycerides. Am J Med Sci. 1969 Feb;257(2):75–80. [PubMed] [Google Scholar]
  40. Sun D. C., Albacete R. A., Chen J. K. Malabsorption studies in cirrhosis of the liver. Arch Intern Med. 1967 Jun;119(6):567–572. [PubMed] [Google Scholar]
  41. Tabaqchali S., Booth C. C. Relationship of the intestinal bacterial flora to absorption. Br Med Bull. 1967 Sep;23(3):285–290. doi: 10.1093/oxfordjournals.bmb.a070573. [DOI] [PubMed] [Google Scholar]
  42. Tamir I., Gould S., Fosbrooke A. S., Lloyd J. K. Serum and adipose tissue lipids in children receiving medium-chain triglyceride diets. Arch Dis Child. 1969 Apr;44(234):180–186. doi: 10.1136/adc.44.234.180. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Tamir I., Grant D. B., Fosbrooke A. S., Segall M. M., Lloyd J. K. Effects of a single oral load of medium-chain triglyceride on serum lipid and insulin levels in man. J Lipid Res. 1968 Sep;9(5):661–666. [PubMed] [Google Scholar]
  44. Tamir I., Hunter J. O., Fosbrooke A. S., Lloyd J. K. Serum and chyle lipids during medium-chain triglyceride feeding in a child with chylothorax. Arch Dis Child. 1968 Jun;43(229):302–306. doi: 10.1136/adc.43.229.302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. WARWICK W. J., HOLMAN R. T., QUIE P. G., GOOD R. A. Chylous ascites and lymphedema. AMA J Dis Child. 1959 Sep;98:317–329. doi: 10.1001/archpedi.1959.02070020319005. [DOI] [PubMed] [Google Scholar]

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