Dietary Supplementation With Medium-Chain Triglycerides Reduces Candida Gastrointestinal Colonization in Preterm Infants

Abstract

Background: Candida is an important cause of infections in premature infants. Gastrointestinal colonization with Candida is a common site of entry for disseminated disease. The objective of this study was to determine whether a dietary supplement of medium-chain triglycerides (MCTs) reduces Candida colonization in preterm infants.

Methods: Preterm infants with Candida colonization (n = 12) receiving enteral feedings of either infant formula (n = 5) or breast milk (n = 7) were randomized to MCT supplementation (n = 8) or no supplementation (n = 4). Daily stool samples were collected to determine fungal burden during a 3-week study period. Infants in the MCT group received supplementation during 1 week of the study period. The primary outcome was fungal burden during the supplementation period as compared with the periods before and after supplementation.

Results: Supplementation of MCT led to a marked increase in MCT intake relative to unsupplemented breast milk or formula as measured by capric acid content. In the treatment group, there was a significant reduction in fungal burden during the supplementation period as compared with the period before supplementation (rate ratio, 0.15; P = 0.02), with a significant increase after supplementation was stopped (rate ratio, 61; P < 0.001). Fungal burden in the control group did not show similar changes.

Conclusions: Dietary supplementation with MCT may be an effective method to reduce Candida colonization in preterm infants.

Figure 1.

Total capric acid received per subject per mL of feeding before, during and after MCT oil supplementation. Subjects 1–4 were in the control group and subjects 5–12 received MCT supplementation. Subjects 4 and 9–12 received formula feedings. Fatty acid composition of feeds given to infants at various times were determined as described in Materials and Methods.

Figure 2.

Fungal burden per study period. Shown are individual colony counts, in colony forming units per gram of stool, for enrolled subjects during each study time period. Each symbol indicates results from a single stool sample. The bar represents median count. Rate ratios (95% confidence intervals) are depicted to reflect the direction and magnitude of change in stool colony counts between time periods for each group.