Fat diet - minimal total
This document is part of the ACI Diet Specifications for Paediatric Inpatients. It is not to be used for patient education.
To provide a diet with no more than 10g total fat per day, for patients with metabolic disorders affecting fat utilisation, or for patients who do not tolerate addition of medium chain triglyceride (MCT) fat in the minimal long chain fat plus MCT diet.
Very low in total fat. Skim dairy foods and very lean meats are used. Fat is not used in cooking or food preparation. Requires additional energy supplements from CHO or protein (if appropriate). May need to be combined with a minimal or reduced protein diet for some metabolic disorders.
For patients with metabolic disorders affecting fat utilisation such as MADD (glutaric aciduria type 2), HMGA Co lyase deficiency, or other disorders of fatty acid oxidation in which tolerance to MCT is a problem or unknown or for patients with pancreatitis.
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. Appropriate nutritional supplements (such as glucose polymers, clear high protein supplement drinks) will 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 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.
Must only be used when ordered by a physician and under the supervision of a dietitian.
Adequate energy intake is essential. Fat-soluble vitamins and essential fatty acid status should be supplemented and monitored regularly as patients may be vulnerable to deficiency, e.g. Vitamin D, E, A, DHA. Assessment and menu planning by a dietitian is essential. Should not be used long term without dietetic advice and regular follow-up.
Patients with pancreatitis should not continue on this diet for more than one week.
Patients with LCHAD deficiency, VLCHAD deficiency, TFP deficiency, chyle leaks/chylothorax, should use minimal long chain fat plus MCT diet code to ensure sufficient energy provision to meet requirements.
For patients with metabolic disorders involving fat and also protein, this diet can be combined with the metabolic minimal protein diet.
Specific menu planning guidelines
|Hot main dishes|
All mains to be <5g total fat per serve (e.g. skinless chicken breast, white fish, very
Soy products (e.g. TVP), legumes and dishes made from them
Egg whites only
All other meats including fatty meats and smallgoods (e.g. bacon, sausages)
Fried foods, including foods fried in MCT oil
Foods cooked with white sauces or coconut milk
Dishes containing cheese
Low fat sauces/gravies <1g long chain fat per serve
Tomato sauce, sweet and sour sauce
Cream- or milk-based sauces
Sauces, gravies with MCT oil
All raw, steamed or boiled
Potato mashed with water or skim milk
Fried/roasted/mashed vegetables with fat such as butter, cooking margarine, oil, cheese sauce
All raw, steamed or boiled without added fat
Fried/roasted/mashed vegetables with fat
Vegetables served with cream- or cheese based
Low fat soups only with <2g fat per serve.
Add 20mL glucose polymer syrup or 10g of glucose powder
All other soups including with added milk, cream, sour cream, coconut milk or cream
<5g fat per serve
Vegemite™, jam, honey
Sliced chicken breast cooked without fat or skin
Deli meat <3% fat
Tuna canned in brine
Cheese <3% fat (e.g. some very low fat cheese slices, cottage cheese, ricotta cheese)
Most cheese, higher fat meat fillings, egg yolk, peanut butter
Margarine, butter, cream cheese, mayonnaise
<5g fat per serve as main meal
Salads containing lean meat, chicken breast, white fish, tuna canned in brine, low fat cheese with <3% fat
Side salad vegetables
Served with fat-free dressing or lemon wedge
Other cheese, higher fat meats
Coleslaw or potato salad
Full fat dressings, mayonnaise
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
Serve with skim milk
Raw muesli with nuts or seeds
Rolled oats made with full cream milk
Cereals with coconut
Jam, honey, Vegemite™
Peanut butter, cream cheese, hazelnut spread
|Hot breakfast choices|
Spaghetti, baked beans (<2% fat)
Egg white only
Grilled plain or herbed tomato
Bacon, sausages, egg yolk
Fresh/canned in syrup/dried fruits
Serve with 20mL glucose polymer syrup (see recipe below) or 10g glucose powder
Juices with added glucose polymer
Fat-free (skim milk) yoghurts (<1% fat)
Full fat or soy yoghurts
Canned and fresh fruit
Desserts made using egg white (<1% fat)
Low fat custard and skim milk dessert (<1% fat)
If <700kJ/serve with 20mL glucose polymer
Cake, pastries, puddings
Dairy/milk based desserts
Desserts containing egg yolk
|Milk and cheese|
Skim milk, Shape™ or milk with <1% fat
Soy beverage with <1% fat
Cottage cheese, ricotta cheese, some very low fat cheese slices (<3% fat)
Milk >1% fat (e.g. full-cream milks, reduced fat milks)
Soy beverage with >1% fat
Cream, sour cream
All other cheeses
Cordials, juices, soft drinks
Skim milk or milk with <1% fat
Low fat nutritional supplements – prescribed by dietitian
Energy content of drinks to be fortified to
|Milk >1% fat|
<2 g fat per serve
Fat-free only (e.g. rice crackers)
Herbs and spices
Lollies (e.g. boiled lollies, jelly snakes)
Nuts and seeds
9kJ/mL Glucose polymer syrup recipe:
56g glucose polymer added to 60mL water (makes 100mL)
- Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
- Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
- Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
- American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
- Mahon LK and Escott-Stump S. 2008. Krause’s Food and Nutrition Therapy. 12th edition. St Louis: Saunders Elsevier.
- Shaw V and Lawson M. 2007. Clinical Paediatric Dietetics. 3rd edition. Blackwell Publishing.
- Acosta PB. 2010. Nutrition Management of Patients with Inherited Metabolic Disorders Jones and Bartlett Publishers.