A MEDIUM-CHAIN TRIGLYCERIDE-BASED DIET IN PATIENTS WITH HIV AND CHRONIC DIARRHEA REDUCES DIARRHEA AND MALABSORPTION - A PROSPECTIVE, CONTROLLED TRIAL

Our objective was to determine whether a medium-chained triglyceride ( MCT)-based diet, compared to a long-chain triglyceride (LCT)-based die t, conveys a beneficial effect on diarrhea and fat malabsorption in hu man immunodeficiency virus (HIV)-infected individuals with chronic dia rrhea and weight loss. A secondary objective was to evaluate the patho gens associated with the diarrhea and to evaluate whether the etiologi c agent was a determinant of response to the nutritional intervention Prospective, randomized double-blind comparative trial was conducted i n 24 adult patients with HIV, diarrhea of greater than 4-wk duration, fat malabsorption, and loss of 10-20% of ideal body weight, these pati ents were recruited from our outpatient infectious disease clinic. Eva luations of diarrheal pathogens were made by complete stool examinatio n, upper and lower endoscopy with quantitative culture, and biopsy. Bo dy composition determinations, and measurements of fat, carbohydrate, and vitamin absorption pre- and postintervention. Patients were random ly assigned to one of two complete nutritional products with either me dium- or long-chain triglyceride fat exclusively for 12 d followed by treatment of infectious pathogens. Ten patients were found to have Mic rosporidium and 9 patients had no identifiable pathogen. All patients responded to intervention with both nutritional products overall with 45% fewer stools, decreased stool fat and weight, and a significant in crease in urine nitrogen. The group that received the MCT product demo nstrated significantly decreased stool number (mean 4 to 2.5), stool f ar (mean 14 to 5.4 g), and stool weight (mean 428 to 262 g) compared w ith baseline (P < 0.01 for all). Patients with both species of microsp oridia and with pathogen negative diarrhea had good response. We found that HIV patients with diarrhea, regardless of etiology, and document ed fat malabsorption may benefit symptomatically from a diet composed of an MCT-based liquid supplement. (C) Elsevier Science Inc.