Fact sheetDiet specifications

Published on 1 Nov 2012


Fat diet - minimal LCT plus MCT

This document is part of the ACI Diet Specifications for Paediatric Inpatients. It is not to be used for patient education.

Aim

To provide a diet low in long chain triglycerides (LCT) and high in medium chain triglycerides (MCT) to bypass lymphatic chylomicron transport and decrease lymph flow or for the management of inborn errors of fatty acid oxidation.

Characteristics

Low fat diet supplemented with MCT oil. Lean meat, dairy products. MCT oil obtained on prescription needs to be incorporated into food prior to service (i.e. added to foods as dressings/sauces; added to beverages). MCT can also be used in baking or shallow frying to boost energy intake. MCT butter may be used to substitute other spreads. Sugars or glucose polymers may be used to add extra energy.

Indications

  • post Chylothorax
  • Chyluria
  • Lymphangiectasia
  • inborn errors of long chain fatty acid oxidation such as long chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD), trifunctional protein deficiency (TFPD), very long chain acyl-CoA dehydrogenase deficiency (VLCAD), carnitine/acylcarnitine translocase deficiency (CACT), carnitine palmitoyl transferase deficiency (CPT)

Nutritional adequacy

This diet may not provide adequate energy and intake of fat soluble vitamins. Essential fatty acids may be compromised and should be assessed by a dietitian. Nutritional supplements and/or high MCT formulas may be required to meet the patient’s energy and/or nutrient needs. Adequate energy intake and avoidance of fasting is essential in the management of inborn errors of long chain fatty acid oxidation to prevent hypoglycaemia. Adequate amounts of essential fatty acids must be provided to prevent deficiency, usually requiring supplementation with very long chain omega 3 fatty acid docosahexaenoic acid (DHA). Supplementation with fat soluble vitamins (A, D, E) may also be required.

Precautions

To be initiated on physician’s advice only and to be used under supervision of a dietitian.

Weight and growth must be monitored regularly. Patients need an authority prescription to obtain MCT oil or high MCT formulas. Advice on how to use in preparation and recipes for use need to be provided. Adequate amounts of essential fatty acids must be provided to prevent deficiency. Monitor progress regularly and re-introduce a normal diet as soon as possible as indicated by medical team.

Specific menu planning guidelines

Allowed Not allowed
Hot main dishes

All mains to be < 6g long chain fat per serve (e.g. skinless chicken breast, white fish, very lean meat, tuna canned in brine)

Soy products (e.g. TVP), legumes and dishes made from them

Egg whites only

MCT could be used for shallow/pan frying or add 10mL MCT oil or equivalent MCT supplement serve to hot main dishes or sauces/gravies to be served with the hot main dish

All other meats including fatty meats and smallgoods (e.g. bacon, sausages, offal)

Fried foods, unless fried in MCT oil

Foods cooked with white sauces or coconut milk

Egg yolks

Pastry, pizza

Dishes containing cheese

Sauces, gravies

Low fat sauces/gravies < 1g long chain fat per serve

Tomato sauce, sweet and sour sauce

Make sauces/gravy with MCT oil or add 10mL MCT oil or equivalent MCT supplement to meal before serving

Cream or milk-based sauces

Starchy vegetables/pasta/rice

All raw, steamed or boiled

Potato mashed with water or skim milk and MCT oil

Fried/roasted/mashed vegetables with fat such as butter, cooking margarine, oil, sour cream, full cream milk, cheese

Vegetables

All raw, steamed or boiled without added fat

Fried/roasted/mashed vegetables with fat such as butter, cooking margarine, oil, sour cream, full cream milk, cheese

Vegetables served with cream or cheese-based sauces

Soups Low fat soups only with < 2g fat per serve

All other soups including with added milk, cream, sour cream, coconut milk

Sandwiches

< 5g fat per serve

Bread (white or wholemeal) with no standard margarine or butter. Can use MCT butter (see recipe below)

Vegemite™, jam, honey

Salad fillings

Sliced chicken breast cooked without fat

Deli meat < 3% fat, tuna canned in brine

Egg white

Cheese < 3% fat (e.g. cheese slices with < 3% fat, cottage cheese, ricotta cheese)

Cheese > 3% fat, higher fat meat fillings, egg yolk, peanut butter

Avocado, olives

Margarine, butter, cream cheese, mayonnaise

Salads, dressings

< 5g fat per serve as main meal

Salads containing lean meat, chicken breast, white fish, tuna canned in brine, low fat cheese <3% fat

Side salad vegetables

Served with fat-free dressing or lemon wedge or 10mL MCT oil dressing

Other cheese, higher fat meats

Coleslaw or potato salad

Full fat dressings; mayonnaise

Olives, avocado

Breads, cereals

Breads, breakfast cereals, rice cakes, corn thins with <2% fat

Rolled oats made on water or skim milk

Raw muesli of rolled oats and dried fruit

Toasted muesli

Raw muesli with nuts or seeds

Rolled oats made with full cream milk

Cereals with coconut or chocolate

Spreads

Jam, honey, Vegemite™, MCT butter (see recipe below)

Butter, margarine

Peanut butter, cream cheese, hazelnut spread

Hot breakfast choices

Spaghetti, baked beans <2% fat, grilled plain or herbed tomatoes

Egg white only

Bacon, sausages, egg yolk

Fruit

Fresh/canned/dried fruits

Juices

Avocado

Yoghurt

Fat-free (skim milk) yoghurts < 1% fat

Full fat or soy yoghurts

Desserts

Canned and fresh fruit, jelly

Meringue, pavlova (meringue only)

Desserts made using egg white < 1% fat

Low fat custard and skim milk dessert < 1% fat

Cake, pastries, puddings

Dairy/milk based desserts

Desserts containing egg yolk

Cream, ice-cream

Milk and cheese

Skim milk, Shape™, milk with < 1% fat

Soy beverage with < 1% fat

Recipe for MCT special skim milk (see below)

Cottage cheese, ricotta cheese, some very low fat cheese slices (< 3% fat)

Milk with > 1% fat, (e.g. full-cream milks)

Soy beverage with > 1% fat

Cream, sour cream

All other cheeses

Beverages

Water

Cordials, juices, soft drinks

Skim milk, Shape™, milk with < 1% fat

Soy beverage with < 1% fat

High MCT formula/nutritional supplements as prescribed by dietitian

Milk with > 1% fat

Soy beverage with > 1% fat

Biscuits

< 2g fat per serve

Fat-free only (e.g. rice crackers)

Biscuits using MCT oil as fat source

Spread crackers with MCT butter if appropriate

All others

Miscellaneous

Herbs and spices

Sugar

Lollies (e.g. boiled lollies, jelly snakes)

Ice blocks

MCT oil/supplement may be prescribed

MCT oil/supplement can be added to gravy, dressings, casseroles, etc.

Glucose polymers

Nuts and seeds

Chocolate

Recipe for MCT butter

1 tablespoon cornflour
¾ cup skim milk powder
1 tablespoon lemon juice
¾ cup water
1 cup MCT oil
few drops yellow food colouring

Method:
Mix dry ingredients with lemon juice and water in a blender
Cook over gentle heat until thickens
Remove from heat and gradually beat in MCT oil
Add yellow colouring
Will keep for 2 weeks in the fridge

Recipe for MCT Special Skim Milk

600mL skim milk
60g skim milk powder
1 tablespoon MCT oil
6 tablespoon glucose polymer powder

Method:
Mix all ingredients together well

References

  1. Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
  2. Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
  3. Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
  4. American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
  5. Mahon LK and Escott-Stump S. 2008. Krause’s Food and Nutrition Therapy. 12th edition. St Louis: Saunders Elsevier.
  6. Smoke A, DeLegge MH. Chyle leaks: consensus on management? Nutr Clin Prac. 2008;23:529-532.
  7. Shaw V and Lawson M. 2007. Clinical Paediatric Dietetics. 3rd Edition. Blackwell Publishing.
  8. Acosta PB. 2010 Nutrition Management of Patients with Inherited Metabolic Disorders Jones and Bartlett Publishers.
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