Influence of Portagen and Pregestimil on Essential Fatty Acid Status in Infantile Liver Disease

Abstract

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

Disease-Related Malnutrition in Pediatric Patients with Chronic Disease: A Developing Country Perspective

“…Moreover, some infants can be supplemented with medium-chain triglyceride (MCT) formulas, whereas older children can be given high-calorie, nutrient-dense drinks. Formula milk containing up to 75% fat as MCTs can be given; however, formula milk with MCTs above 80% can worsen steatorrhea and bring about essential fatty acid deficiency [ 51 ]. These can be given either orally or nasogastrically as required.…”