USE OF MEDIUM-CHAIN TRIGLYCERIDE DIETS IN CHILDREN WITH MALABSORPTION

Medium-chain triglyceride (MCT) diets have been used in the treatment of 13 children with malabsorption due to four groups of disorders: obstructive jaundice, pancreatic insufficiency, a-ß-lipoproteinaemia, and intestinal lymphangiectasia. The diets consisted of a low intake of ordinary dietary fat (long-chain triglyceride) together with the addition of medium-chain triglyceride as an oil for cooking or in a milk formula. The role of MCT in the diet is to increase palatability and provide additional calories. A method for faecal fat estimation suitable for use in patients receiving MCT diets is described. MCT diets controlled the steatorrhoea in all four groups of disorders. Analysis of the faecal fatty acid pattern showed that MCT absorption was somewhat impaired where bile or pancreatic lipase was deficient, but was virtually complete in intestinal lymphangiectasia and a-ß-lipoprotein- aemia where the intraluminar phase of fat digestion was normal. Control of steatorrhoea improved the general well-being of all the children. In those with lymphangiectasia serum albumin levels rose, generalized oedema disappeared, and in one child marked acceleration of growth occurred. No significant effect on growth rate was observed in the children with obstructive jaundice, pancreatic insufficiency, or a-ß-lipoproteinaemia, though in these children factors other than malabsorption may have contributed to their growth retardation.