Nutritional support of the pediatric patient with chronic liver disease continues to pose a challenge to physicians. These patients frequently are profoundly anorexic, have reduced assimilation of dietary fats from intestinal bile acid deficiency and have increased caloric requirements because of hypermetabolism.1 Provision of formula by nasogastric tube may effectively circumvent anorexia while providing additional calories.2 Traditionally, supplying a substantial portion of lipid intake as medium-chain triglyceride (MCT) has also been advocated.3 Rationale for use of MCT in place of usual dietary lipid, ie, long-chain triglyceride (LCT), has included the former's partial hydrolysis and absorption within the stomach, more rapid hydrolysis by pancreatic lipase in the intestinal lumen, and reduced requirement for bile salts to effect aqueous dispersion of free medium-chain fatty acids prior to absorption by intestinal epithelium.4
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