|Arsenault, Amanda - Women & Infants Hospital Of Rhode Island|
|Gunsalus, Kearney - Tufts University|
|Laforce-nesbitt, Sonia - Women & Infants Hospital Of Rhode Island|
|Przystac, Lynn - Women & Infants Hospital Of Rhode Island|
|Deangelis, Erik - Women & Infants Hospital Of Rhode Island|
|Hurley, Michaela - Women & Infants Hospital Of Rhode Island|
|Vorel, Ethan - Brown University|
|Tucker, Richard - Women & Infants Hospital Of Rhode Island|
|Matthan, Nirupa - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
|Lichtenstein, Alice - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
|Kumamoto, Carol - Tufts University|
|Bliss, Joseph - Women & Infants Hospital Of Rhode Island|
Submitted to: The Pediatric Infectious Disease Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/20/2018
Publication Date: 4/24/2018
Citation: Arsenault, A.B., Gunsalus, K., Laforce-Nesbitt, S.S., Przystac, L., DeAngelis, E., Hurley, M., Vorel, E., Tucker, R., Matthan, N., Lichtenstein, A.H., Kumamoto, C., Bliss, J. 2018. Dietary supplementation with medium-chain triglycerides reduces candida gastrointestinal colonization in preterm infants. The Pediatric Infectious Disease Journal. https://doi.org/10.1097/INF.0000000000002042.
DOI: https://doi.org/10.1097/INF.0000000000002042 Interpretive Summary: Candida albicans is the most common human fungal pathogen, particularly in human infants and elderly. Infections arise from pre-existing colonization of the gastrointestinal tract, where C. albicans is part of the normal microflora. In a well-established adult murine model of gastrointestinal colonization with Candida albicans, dietary fatty acids were found to have a significant impact on colonization. A diet containing coconut oil, which is high in medium-chain fatty acids, reduced the ability of C. albicans to establish colonization and reduced fungal burden in mice previously colonized with C. albicans. These data suggest that a change in the fatty acid composition of gastrointestinal contents promoted by feeding medium-chain fatty acids would reduce gastrointestinal colonization. This pilot study was conducted to test the hypothesis that dietary supplementation with medium-chain triglycerides will reduce the amount of Candida in the intestinal tract. Our findings indicate that dietary supplementation with medium-chain fatty acids may be an effective non-pharmacological method to reduce Candida colonization in the gastrointestinal tract. This reduction in gastrointestinal colonization may ultimately lead to a reduction in the rate of invasive candidiasis in high-risk populations.
Technical 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 receiving enteral feedings of either infant formula (n=5) or breastmilk (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 to the periods before and after supplementation. RESULTS: Stool Candida fungal burden was similar in control and treatment groups before supplementation (p=0.81). In the treatment group, there was a significant reduction in fungal burden during the supplementation period as compared to the period before supplementation (p<.0001). A trend toward reduced fungal burden was noted after stopping supplementation (p=0.05). Fungal burden in the control group did not show similar changes. CONCLUSION: Dietary supplementation with MCT may be an effective method to reduce Candida colonization in preterm infants.