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We also use it, and especially in those patients with bronchopulmonary dysplasia, where CO2 production is not desirable. MCT generates less CO2 than glucose for energy production, consequently reducing respiratory work.

  • 2 weeks later...

In conditions when reducing feeding volumes and total fluid intakes are deemed necessary, MCT oil may provide some help; they are after all rich in calories. However, NO significant differences in short-term growth markers have been reported for infants fed low versus high MCT formulas. (https://pubmed.ncbi.nlm.nih.gov/33620090/)

Moreover, the glucose oxidation in infants fed formulas with high MCT content was reported to be significantly decreased, suggesting that a larger portion of carbohydrate was used in the nonoxidative pathway ( lipogenesis), i. e., it is utilized to generate further fat, not muscle mass or new cells in various tissues.

Another concern is that providing large quantities of MCT in the diet, may predispose infants to the deficiency of unsaturated fatty acids and some fat-soluble vitamins. Notably, the caloric value of the MCTs, compared to long-chain triglycerides, is lower.

Finally, formulas with MCT have a igher osmolality, therefore, MCT is not recommended as an additive to standard formulas for healthy infants, and its use should be restricted to clearly indicated conditions, such as short bowel syndrome.

Intrestingly, formulas designed specifically for preterm infants contain 25% to 50% of total fatty acids as MCT. Whereas, in human milk, MCT constitutes about 8% to 10% of the total fatty acids.

All being said, adding more MCT to the diet of a preterm infant, who is already on a formula rich in this type of fat, seems unjustified. 

Thanks Kaltirkawi - I agree, I have never been convinced that adding MCT oil to promote growth (as opposed to weight gain) is truly beneficial. I am sure it increases weight gain  - there are extra calories and CO2 production is less than glucose; but I would be concerned that the 'weight gain' is primarily fat. Most preterm infants with slow growth are probably getting insufficient protein - very likely to be true if using donor milk, but probably also true with MOM. So adding MCT might appear to improve 'growth' but it might 'hide' the underlying issue. Without access to a pure protein fortifier that allows you to adjust the intake, it is a complex problem. Blood urea is typically low in these babies but variability means the predictive value (for protein intake) of Urea is poor  - however if i observed 'slow growth' with a urea of <3mmol/L AND the baby was on fortified 180-200ml/kg I might add extra protein, or if no protein supplement, cautiously increase the amount of fortifier. In Arslanoglu trials this approach improved head growth. 

 

Arslanoglu S, Moro GE, Ziegler EE. Adjustable fortification of human milk fed to preterm infants: does it make a difference? J Perinatol. 2006 Oct;26(10):614-21. doi: 10.1038/sj.jp.7211571. Epub 2006 Aug 3. PMID: 16885989.

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