Medium-chain triglyceride supplementation and the association with growth, nutritional status and clinical outcomes in infants with biliary atresia

Sara Mancell; Anil Dhawan; Gillian Geaney; Salma Ayis; Kevin Whelan

doi:10.1016/j.clnu.2024.11.028

Medium-chain triglyceride supplementation and the association with growth, nutritional status and clinical outcomes in infants with biliary atresia

Clin Nutr. 2024 Dec 2:44:134-146. doi: 10.1016/j.clnu.2024.11.028. Online ahead of print.

Authors

Sara Mancell¹, Anil Dhawan², Gillian Geaney³, Salma Ayis⁴, Kevin Whelan⁵

Affiliations

¹ Department of Nutritional Sciences, King's College London, London, UK; Department of Nutrition & Dietetics, King's College Hospital NHS Foundation Trust, London, UK. Electronic address: sara.mancell@nhs.net.
² Paediatric Liver, GI and Nutrition, King's College Hospital NHS Foundation Trust, London, UK.
³ Department of Nutrition & Dietetics, King's College Hospital NHS Foundation Trust, London, UK.
⁴ School of Life Course and Population Sciences, King's College London, UK.
⁵ Department of Nutritional Sciences, King's College London, London, UK.

PMID: 39667195
DOI: 10.1016/j.clnu.2024.11.028

Abstract

Background and aims: Infants with biliary atresia experience gastrointestinal malabsorption of long-chain triglycerides and are commonly supplemented with medium-chain triglyceride (MCTs) that can be passively absorbed. The aim was to investigate the association of MCT supplementation with growth, nutritional status and clinical outcomes in infants with biliary atresia.

Methods: Infants who underwent Kasai portoenterostomy and were followed up for at least two years or until death or transplantation were reviewed. Infants with comorbidities affecting growth or outcome were excluded. Data were extracted from medical records from more than a decade in relation to MCT supplementation, growth, nutritional status and clinical outcome at baseline, 6-weeks, 3-, 6-, 12- and 24-months. Mixed-effects modelling was used to test associations of MCT in the first six months with these outcomes.

Results: Of 200 infants (108 male), 108 (54 %) were alive with native liver at two years, 84 (42 %) underwent liver transplantation and eight (4 %) died. MCT percentage prescribed was mean 57.3 % (SD 11.2) while MCT intake was median 2.7 (IQR 2.2, 3.8) g/kg/d. For every g/kg/d MCT consumed, the rate of change in z-score for weight was -0.27 (95 % CI -0.37 to -0.17) and length was -0.31 (-0.42 to -0.17) (both p < 0.001). Compared to the low MCT group (<2.7 g/kg/d), the high group (≥2.7 g/kg/d) consumed more energy (118 vs. 108 kcal/kg; p < 0.001), however, at 3-months they had lower weight (-1.7 (1.2) v. -1.0 (1.2) and length (-1.3 (1.1) v. -0.6 (1.4) z-scores (both p < 0.001) but no differences in growth at later time points. There was no overall association between MCT and nutritional status or clinical outcomes.

Conclusions: This is the first study to investigate the association of MCT with growth, nutritional status and clinical outcomes in biliary atresia. No association was found between MCT with growth beyond 3-months, overall nutritional status or clinical outcomes. The association between MCT (g/kg/d) and poorer growth in the first 3-months may be explained by infants with poorer growth drinking more or being prescribed more MCT formula milk. A randomised controlled trial could help to better understand this association.

Keywords: Biliary atresia; Cholestasis; Infants; MCT; Medium-chain triglyceride; Nutrition.