Medium-chain triglyceride diet: its use in treatment of liver disease.
Authors: V. Burke, D. M. Danks
Journal: BMJ (1966)

Three years ago, when starting an investigation of infants with neonatal hepatitis or biliary atresia, we observed that some of these babies passed stools which appeared to contain excessive fat.Balance studies in these infants confirmed the presence of severe steatorrhoea.The slow growth seen in children with liver disease has traditionally been attributed to "poor liver function."Our findings suggested that steatorrhoea might be an important factor even in those patients whose bowel motions were not so obviously abnormal.Fat-balance studies were therefore made in all our patients with liver disease investigated during the past two years.This group comprised nine infants with biliary atresia, 17 with neonatal hepatitis, and six older children with chronic liver disease.Thirty-one of these 32 patients excreted more than 5 g. of fat daily, and absorption ranged from 20 to 80% of ingested fat.In 17 less than 60 % of the dietary fat was absorbed.Although it seemed likely that the absence of biliary secretions from the intestine was responsible for the steatorrhoea, no correlation was found between the presence of complete biliary obstruction and the amount of fat excreted.Studies of the possible mechanism of the malabsorption are in progress, and will be reported later.Attempts to improve fat-absorption seemed worth while.Death may result from infection in an emaciated infant with neonatal hepatitis, and impaired healing of the wound is an important cause of morbidity after operations on babies with obstructive jaundice.In adults with steatorrhoea and liver disease, supplements of bile salts, pancreatic extract, and bicarbonate have produced variable results, but, overall, the response to these measures has not been encouraging (Summerskill and Moertel, 1962).Similarly, this therapy caused no consistent change in the fat-absorption of our patients.Another approach to the management of these children was suggested by reports that medium-chain tri- glycerides having a chain length of 8-12 carbon atoms are more easily absorbed than the usual dietary long-chain fats in a number of diseases associated with malabsorption (Fernandes et al., 1962).Medium-chain triglycerides are absorbed by a different mechanism from that for long-chain fats.In the absence of pancreatic and biliary secretion, the absorption of long-chain fats is poor, but that of medium-chain triglycerides is less severely affected (Isselbacher, 1966).Investigation of the value of medium-chain triglycerides in these patients was undertaken in two ways.After changing to a diet in which a large proportion of the fat was in the form of medium-chain triglycerides, faecal-fat excretion was measured during a period of at least three days, and in more- prolonged feeding trials the growth rate was recorded.Balance studies were repeated in 18 patients who presented after a preparation of medium-chain triglycerides became available 18 months ago.In every case the faecal-fat excretion decreased greatly (see Table ).Initially a medium-chain triglyceride oil (E.F. Drew Co.) was used, but 12 months ago a palatable milk (Mead Johnson) containing most of its fat as medium-chain triglycerides became available to us.This milk formula has been well tolerated, and long-term feeding trials are now in progress.