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

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.