Medium chain triglyceride supplement

Rebello, C. J., Keller, J. N., Liu, A. G., Johnson, W. D. Greenway, F. L. (2015). Pilot feasibility and safety study examining the effect of medium chain triglyceride supplementation in subjects with mild cognitive impairment A randomized controlled trial. BBA Clinical, 3, 123-125. 

Pancreatic enzyme supplements should be taken immediately prior to meals to aid in the digestion and absorption of food. Alternately, patients can supplement their diet with medium chain triglycerides (MCTs) or ingest foods rich in MCTs since they do not require pancreatic enzymes for absorption. An appropriate regimen incorporates the successful doses of each enzyme (amylase, lipase, and protease) from the starting non-enteric-coated regimen. As with the previous example, a patient stabilized on Viokase-8, six tablets with each meal, can be transitioned to Pancrease MT-16 three tablets with meals. The famotidine can then be discontinued. 

Type V hyperlipoproteinemia requires stringent restriction of dietary fat intake. Drug therapy with fibrates or niacin is indicated if the response to diet alone is inadequate. Medium-chain triglycerides, which are absorbed without chylomicron formation, may be used as a dietary supplement for caloric intake if needed for both types I and V. 

The benefits and safety of parenteral nutrition have been considerably improved in recent years by innovative strategies, such as supplementation with medium-chain triglycerides, glutamine, or branch-chain amino acids. 

Patient 20 has been shown to be mosaic for a PEX6 defect (Moser, 1999). Cultured skin fibroblasts and liver biopsy samples have demonstrated a mixture of normal and abnormal cells (Pineda, et al., 1999). The patient is now 16 yr old. Developmental milestones were delayed at 2 yr. Liver biopsy showed micronodular cirrhosis. Neurologic exam at 3.5 yr showed nystagmus, head tremor, and generalized spasticity, and he was unable to walk. At 4 yr of age, he was started on a diet containing medium-chain triglycerides, pure olive oil (20% of daily fat intake), and vitamin A supplementation. This coincided with clinical improvement as evidence by the disappearance of abnormal eye movements and head tremor and reduction of spasticity. This improvement was attributed to a reduction in phytanic acid levels. Visual evoked responses improved between 4 and 6 yr of age. DHA therapy was added to the regimen at age 6.7 yr. Further improvement of the visual evoked responses occurred. At 12 yr, motor and mental improvements have been maintained. He is able to stand with support. His IQ is 60 and he attends a special school. 

Medium-chain triglycerides (MCT) are important components of nutritional supplements used in patients with digestive disorders. They therefore can be employed as an easily absorbed source of calories in patients who have a gastrointestinal (Gl) disorder that may result in malabsorption of nutrients. These diseases include pancreatic insufficiency, intraluminal bile salt deficiency due to cholestatic liver disease, biliary obstruction, ileal disease or resection, and disease causing obstruction of intestinal lymphatics. Remember, however, that MCT do not contain polyunsaturated fatty acids that can be used for synthesis of eicosanoids (see Chapter 35). 

Case report The patient was first described by Niezen-Koning et al. She presented at 36 hours of age with sudden cardiorespiratory insufficiency and extreme hypogly-caemia. Despite treatment with low-fat diet supplemented with medium-chain triglycerides and carnitine she died at 24 month of age. 

If the gut tolerance is for only very small volumes, we have supplemented 0.9 cal/ml - 1.0 cal/cc feeding with the addition of medium chain triglyceride oil 0.5 - 1.0 ml per feeding. 

To treat the malabsorption and subsequent diarrhea, lipid-poor diets (<5 g/day) should be implemented with a restriction of triglycerides containing long-chain fatty acids. Medium-chain fatty acids rely on other protein carriers besides apoB (i.e., albumin) for plasma transport, making them an ideal lipid substitute. However, long-term supplementation should be cautioned as associated hepatic fibrosis could occur. Diets should also contain increased protein and carbohydrate content to compensate for caloric loss from fat restriction. 

Scalfi, L., Coltorti, A. Contaldo, F. (1991). Postprandial thermogenesis in lean and obese subjects after meals supplemented with medium-chain and long-chain triglycerides. Am. 

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