Manual of Clinical Nutrition Management C- 57 Copyright © 20 13 Compass Group, Inc.
MEDIUM-CHAIN TRIGLYCERIDES (MCT)
Description
Commercial medium-chain triglycerides (MCT) are composed of 8 to 10 carbon fatty acids synthesized from
palm kernel and coconut oils (1). MCT provide 8.3 kcal per g and 116 kcal per tablespoon (2).
Indications
MCT are indicated in conditions where long-chain triglycerides (LCT) are not well tolerated. MCT are
commonly used in fat-controlled diets to provide increased calories and improve the palatability of a reduced-
fat diet See Section 1C: Fat-Controlled Diet. The following properties of MCT may make it useful in disorders
where LCT are problematic:
Absorption can occur despite pancreatic lipase deficiency (2).
Bile salts or micelles are not required for dispersion in water and subsequent absorption (2).
Transport across the intestinal mucosa occurs more readily than with LCT (2).
MCT are not dependent upon chylomicrons for transit and consequently do not require lipoprotein lipase
for oxidation (2).
Transport does not occur through the lymphatic system. MCT travel directly to the liver via the portal vein,
as free fatty acids bound to albumin (2).
MCT hydrolyzes to fatty acids more quickly (2) and oxidizes more rapidly and efficiently than LCT (1).
MCT may be adjunctive to a fat-controlled diet in the following conditions:
pancreatic insufficiency (1)
cystic fibrosis (1)
intestinal resection (1)
hepatobiliary disease (1)
lymphangiectasia (2)
chyluria (2)
chylous ascites (2)
chylothorax (2)
secondary carnitine deficiency syndromes (3)
whipple’s disease (4)
hyperchylomicronemia (4)
MCT may be therapeutically incorporated into the ketogenic diet, which is used to control epileptic seizures
(see Section IE: Ketogenic Diet) and may also be used in adjunct with antineoplastic treatment for pediatrics (5).
Contraindications
Under normal physiologic conditions, MCT are ketogenic. Therefore, MCT are contraindicated in persons who
are prone to diabetic ketoacidosis (2).
In cirrhosis, MCT accumulate in the blood, resulting in a condition that presents with symptoms similar to
hepatic encephalopathy, including hyperlactacidemia, hyperammonemia, hyperventilation, and altered EKG
findings (2).
Nutritional Adequacy
MCT are used in conjunction with specific diets, such as fat-controlled or ketogenic diets. Nutritional adequacy
will depend on the prescribed diet.
How to Order the Diet
MCT are generally ordered in conjunction with a fat-controlled diet. The order should specify the number of mL
or g MCT to be added to the diet. For example: “ g Fat-Controlled Diet plus mL (g) MCT”.
Planning the Diet