Medium-chain triglycerides and the impact on fat absorption, growth, nutritional status and clinical outcomes in children with cholestatic liver disease: A scoping review

TY - JOUR

T1 - Medium-chain triglycerides and the impact on fat absorption, growth, nutritional status and clinical outcomes in children with cholestatic liver disease: A scoping review

AU - Mancell, S.

AU - Manwani, K.

AU - Dhawan, A.

AU - Whelan, K.

N1 - Funding Information: Sara Mancell, Clinical Doctoral Research Fellow (NIHR302152), is funded by Health Education England (HEE)/National Institute for Health Research (NIHR) for this research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, National Health Service or the UK Department of Health and Social Care. Funding Information: Sara Mancell, Clinical Doctoral Research Fellow (NIHR302152), is funded by Health Education England (HEE)/National Institute for Health Research (NIHR) for this research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, National Health Service or the UK Department of Health and Social Care. Publisher Copyright: © 2023 The Author(s)

PY - 2023/11

Y1 - 2023/11

N2 - Background & aims: Medium-chain triglyceride (MCT) supplementation is recommended in cholestatic liver disease, despite unclear evidence and no consensus on the ideal percentage of fat that should be MCT. The aim was to undertake a scoping review to identify the extent and type of evidence regarding how MCT supplementation, and percentage of MCT, affects fat absorption, growth, nutritional status and clinical outcomes (morbidity, mortality, transplant) in children with cholestatic liver disease. Methods: Nine databases (MEDLINE, Embase, CINAHL, PubMed, AMED, Cochrane Library, Global Health, Scopus, Proquest) were searched from inception, with hand-searching conference abstracts and forward/backward citation searching. Eligible studies investigated oral/enteral MCT supplementation in children under 18y with cholestatic liver disease. There were no language limits. Two reviewers performed screening and data extraction independently. Data were synthesised narratively. Results: Following title/abstract screening (1202 studies) and full-text review (40 studies), 24 studies were included comprising three small RCTs (n = 19 patients), one non-randomised controlled trial (n = 2), seven uncontrolled trials (n = 83) and thirteen case series/reports (n = 211). Seventeen studies were published before 1994. Outcomes included absorption, growth and nutritional status. MCT supplementation was associated with greater fat absorption (9/9 studies) and improved growth in some children (2/4). Higher percentage MCT was associated with greater magnesium and calcium absorption (1/1), essential fatty acid (EFA) deficiency (4/4), but not growth (3/3). Conclusions: The limited, mostly observational evidence from >30 years ago points to greater fat absorption on MCT and EFA deficiency on very high percentage MCT. High quality RCTs are required, particularly examining the impact of MCT at different percentages on growth, nutritional status and clinical outcomes.

AB - Background & aims: Medium-chain triglyceride (MCT) supplementation is recommended in cholestatic liver disease, despite unclear evidence and no consensus on the ideal percentage of fat that should be MCT. The aim was to undertake a scoping review to identify the extent and type of evidence regarding how MCT supplementation, and percentage of MCT, affects fat absorption, growth, nutritional status and clinical outcomes (morbidity, mortality, transplant) in children with cholestatic liver disease. Methods: Nine databases (MEDLINE, Embase, CINAHL, PubMed, AMED, Cochrane Library, Global Health, Scopus, Proquest) were searched from inception, with hand-searching conference abstracts and forward/backward citation searching. Eligible studies investigated oral/enteral MCT supplementation in children under 18y with cholestatic liver disease. There were no language limits. Two reviewers performed screening and data extraction independently. Data were synthesised narratively. Results: Following title/abstract screening (1202 studies) and full-text review (40 studies), 24 studies were included comprising three small RCTs (n = 19 patients), one non-randomised controlled trial (n = 2), seven uncontrolled trials (n = 83) and thirteen case series/reports (n = 211). Seventeen studies were published before 1994. Outcomes included absorption, growth and nutritional status. MCT supplementation was associated with greater fat absorption (9/9 studies) and improved growth in some children (2/4). Higher percentage MCT was associated with greater magnesium and calcium absorption (1/1), essential fatty acid (EFA) deficiency (4/4), but not growth (3/3). Conclusions: The limited, mostly observational evidence from >30 years ago points to greater fat absorption on MCT and EFA deficiency on very high percentage MCT. High quality RCTs are required, particularly examining the impact of MCT at different percentages on growth, nutritional status and clinical outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85172710871&partnerID=8YFLogxK

U2 - 10.1016/j.clnu.2023.09.010

DO - 10.1016/j.clnu.2023.09.010

M3 - Article

SN - 0261-5614

VL - 42

SP - 2159

EP - 2172

JO - CLINICAL NUTRITION

JF - CLINICAL NUTRITION

IS - 11

ER -