Home⇛The PCMC Journal⇛vol. 14 no. 2 (2018)

Efficacy of Virgin Coconut Oil Supplemented-Milk Feeding in Augmenting Weight Gain among Very Low Birth Weight Preterm Infants: A Meta-Analysis

Alissa D Barcelona | Michael M. Resurreccion

Discipline: medicine by specialism

 

Abstract:

BACKGROUND: Nutritional status is crucial in neonatal survival, especially among the Very Low Birthweight (VLBW) preterm infants. They have low nutrient reserves with increased metabolic needs and immature gut system. Several studies have proven the efficacy of medium-chain triglycerides (MCT) as good source of calories among preterm infants. However, such is not commercially available. Virgin coconut oil (VCO) has the most concentrated content of MCTs, hence a possible source of MCT. OBJECTIVES: This review aims to determine the efficacy of VCO-supplementation to milk feeding in augmenting weight gain among very low birthweight preterm infants. METHODS: Pubmed (1975- September 2016), Cochrane Central Register of Controlled Trials (The Cochrane Library, September 2016), HERDIN (1966-September 2016), Google Scholar (September 2016), and https://clinicaltrials.gov (last searched September 2016) were thoroughly searched. Manual search in reference and citation lists of the eligible studies, and list of abstracts from the Philippine Pediatric Society was also reviewed. Only randomized controlled trials comparing VCO-supplemented milk versus standard care in weight gain among very low birthweight preterm infants were included. The author reviewed each study’s quality and extracted data on weight gain. Weighted mean differences with 95% confidence intervals were reported. Risk of biases among studies were also evaluated. RESULTS: Three randomized controlled trials involving 290 infants were included. All trials were of good quality with relatively low heterogeneity (39%), and low risk of biases. Overall, infants receiving VCO-supplemented milk feeding had statistically significant weight gain compared to those given nonfortified milk (Mean difference 5.31, 95% CI: 3.83 to 11.93). CONCLUSIONS: Virgin coconut oil is effective in augmenting weight gain among very low birthweight preterm infants. RECOMMENDATIONS: Small trials were used in this review, and a single multicenter randomized controlled trial would be ideal to further establish these findings.



References:

  1. Cloherty JP, Eichenwald EC, Hansen AR, Stark AN. Manual of Neonatal Care. 7th ed. Philadelphia (PA): Wolters Kluwer, Lippincott Williams & Wilkins; 2012. p. 230–260.
  2. August D, et al. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 2002 Jan–Feb;26(1 Suppl):46SA–47SA.
  3. Dragomir C, Florescu L, Starcea M. Nutrition of low birth weight infants. Rev Med Chir Soc Med Nat Iasi. 2008 Jan–Mar;112(1):35–41. [Article in Armenian].
  4. American Academy of Pediatrics. Breastfeeding and human milk. Pediatrics. 2012;129(3):e827–e841. ISSN: Print 0031-4005; Online 1098-4275.
  5. Rönnholm KA, Perheentupa M, Siimes M. Supplementation with human milk protein improves growth of small premature infants fed human milk. J Pediatr. 1986 May;77(5):649–653. Helsinki, Finland.
  6. Brumberg HL, et al. Randomized trial of enteral protein and energy supplementation in infants ≤1250 g at birth. J Perinatol. 2010;30:517–521. New York (NY), USA.
  7. Vaidya UV, Hegde VM, Bhave SA, Pandit AN. Vegetable oil fortified feeds in the nutrition of very low birthweight babies. Indian Pediatr. 1992;29:1519–1527.
  8. Armand M, et al. Effect of human milk or formula on gastric function and fat digestion in the premature infant. Pediatr Res. 1996;40:429–437. Washington (DC), USA.
  9. Hamosh M, Bitman J, Liao T, et al. Gastric lipolysis and fat absorption in preterm infants: effect of medium-chain triglyceride or long-chain triglyceride-containing formulas. Pediatrics. 1989;83:86–92.
  10. Hamosh M, Mehta NR, Fink CS, et al. Fat absorption in premature infants: medium-chain triglycerides and long-chain triglycerides are absorbed from formula at similar rates. J Pediatr Gastroenterol Nutr. 1991;13:143–149.
  11. Okamoto E, Muttart CR, Zucker CL, et al. Use of medium-chain triglycerides in feeding the low-birth-weight infant. Am J Dis Child. 1982;136:428–431.
  12. Sulkers EJ, Lafeber HN, Degenhart HJ, et al. Comparison of two preterm formulas with or without addition of medium-chain triglycerides (MCTs). II: Effects on mineral balance. J Pediatr Gastroenterol Nutr. 1992;15:42–47.
  13. Whyte RK, Campbell D, Stanhope R, et al. Energy balance in low birth weight infants fed formula of high or low medium-chain triglyceride content. J Pediatr. 1986;108:964–971.
  14. Estrallado WL. Randomized controlled trial on the use of MCT-supplemented premature milk formula in augmenting weight gain among infants <35 weeks gestation. Philipp J Pediatr. 1999;48(4):Oct–Dec.
  15. Genen NV, Brumberg HL. High versus low medium-chain triglyceride content of formula for promoting short-term growth of preterm infants (Review). Cochrane Database Syst Rev. 2002;(3):CD002777.
  16. Fife B. Coconut oil and medium chain triglycerides. [Internet]. Available from: Web archive.
  17. Enig M. Coconut: In support of good health in the 21st century. [Internet]. 1999. Available from: www.mercola.com/2001/jul/28/coconut_health.htm
  18. Satheesh N. Review on production and potential application of virgin coconut oil. Ann Food Sci Technol. 2015;16(1). Valahia University Press.
  19. Amante-Aurelio MR, Mantaring JB III. A randomized controlled trial on the use of virgin coconut oil in augmenting weight gain among infants weighing 1500 g or less: preliminary results. Phil J Pediatr. 2005;54(4):223–229. Oct–Dec.
  20. Banzali LK, Masangkay SA. The use of virgin coconut oil-supplemented expressed breast milk in augmenting weight gain among neonates <35 weeks gestation: a pilot study. Phil Children’s Med Center J. 2006.
  21. Baluyot-Martonito MG, Ferrer J. The effect of virgin coconut oil supplementation on the nutritional status of children 7 months to 18 years old sheltered in a home care institution in Cavite. Unpublished study.
  22. Aguilar-Gonzales RA. A randomized controlled trial on the use of virgin coconut oil in augmenting weight gain among 3–6 year-old children in a daycare center at Tala, Caloocan City. Unpublished study.
  23. Aguinaldo LB. Effect of virgin coconut oil supplementation on weight and height among underweight children aged 10–14 years in a shelter in Quiapo, Manila. Unpublished study.
  24. Deasy MD, Dechangchon MV. The efficacy of virgin coconut oil in improving the nutritional status (weight and height) of children aged 1–5 years enrolled in a feeding program: a community-based, double-blind randomized controlled clinical trial. Unpublished study.
  25. Agrimano MM, Bravo LC, Gonzales ML, Maramba C, Torres ML. Effect of virgin coconut oil on weight gain among pediatric TB patients undergoing short-course chemotherapy. UP Manila J. 2011;14:Oct.
  26. Mantaring JBV, Aurelio MA, Santiago VD. Virgin coconut oil for the prevention of sepsis among preterm neonates weighing 1500 g in UP-PGH: a randomized controlled trial. UP Manila J. 2007.
  27. Dayrit CS, et al. Structured lipid of coconut and corn oil vs soybean oil in the rehabilitation of malnourished children: a field study. Phil J Intern Med. 1992;30:159–164. May–Jun.

Singhania RU, Bansal A, Sharma JN. Fortified high-calorie human milk for optimal growth of low birth weight babies. J Trop Pediatr. 1989;35(2):77–78.

  1. Cloherty JP, Eichenwald EC, Hansen AR, Stark AN. Manual of Neonatal Care. 7th ed. Philadelphia (PA): Wolters Kluwer, Lippincott Williams & Wilkins; 2012. p. 230–260.
  2. August D, et al. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 2002 Jan–Feb;26(1 Suppl):46SA–47SA.
  3. Dragomir C, Florescu L, Starcea M. Nutrition of low birth weight infants. Rev Med Chir Soc Med Nat Iasi. 2008 Jan–Mar;112(1):35–41. [Article in Armenian].
  4. American Academy of Pediatrics. Breastfeeding and human milk. Pediatrics. 2012;129(3):e827–e841. ISSN: Print 0031-4005; Online 1098-4275.
  5. Rönnholm KA, Perheentupa M, Siimes M. Supplementation with human milk protein improves growth of small premature infants fed human milk. J Pediatr. 1986 May;77(5):649–653. Helsinki, Finland.
  6. Brumberg HL, et al. Randomized trial of enteral protein and energy supplementation in infants ≤1250 g at birth. J Perinatol. 2010;30:517–521. New York (NY), USA.
  7. Vaidya UV, Hegde VM, Bhave SA, Pandit AN. Vegetable oil fortified feeds in the nutrition of very low birthweight babies. Indian Pediatr. 1992;29:1519–1527.
  8. Armand M, et al. Effect of human milk or formula on gastric function and fat digestion in the premature infant. Pediatr Res. 1996;40:429–437. Washington (DC), USA.
  9. Hamosh M, Bitman J, Liao T, et al. Gastric lipolysis and fat absorption in preterm infants: effect of medium-chain triglyceride or long-chain triglyceride-containing formulas. Pediatrics. 1989;83:86–92.
  10. Hamosh M, Mehta NR, Fink CS, et al. Fat absorption in premature infants: medium-chain triglycerides and long-chain triglycerides are absorbed from formula at similar rates. J Pediatr Gastroenterol Nutr. 1991;13:143–149.
  11. Okamoto E, Muttart CR, Zucker CL, et al. Use of medium-chain triglycerides in feeding the low-birth-weight infant. Am J Dis Child. 1982;136:428–431.
  12. Sulkers EJ, Lafeber HN, Degenhart HJ, et al. Comparison of two preterm formulas with or without addition of medium-chain triglycerides (MCTs). II: Effects on mineral balance. J Pediatr Gastroenterol Nutr. 1992;15:42–47.
  13. Whyte RK, Campbell D, Stanhope R, et al. Energy balance in low birth weight infants fed formula of high or low medium-chain triglyceride content. J Pediatr. 1986;108:964–971.
  14. Estrallado WL. Randomized controlled trial on the use of MCT-supplemented premature milk formula in augmenting weight gain among infants <35 weeks gestation. Philipp J Pediatr. 1999;48(4):Oct–Dec.
  15. Genen NV, Brumberg HL. High versus low medium-chain triglyceride content of formula for promoting short-term growth of preterm infants (Review). Cochrane Database Syst Rev. 2002;(3):CD002777.
  16. Fife B. Coconut oil and medium chain triglycerides. [Internet]. Available from: Web archive.
  17. Enig M. Coconut: In support of good health in the 21st century. [Internet]. 1999. Available from: www.mercola.com/2001/jul/28/coconut_health.htm
  18. Satheesh N. Review on production and potential application of virgin coconut oil. Ann Food Sci Technol. 2015;16(1). Valahia University Press.
  19. Amante-Aurelio MR, Mantaring JB III. A randomized controlled trial on the use of virgin coconut oil in augmenting weight gain among infants weighing 1500 g or less: preliminary results. Phil J Pediatr. 2005;54(4):223–229. Oct–Dec.
  20. Banzali LK, Masangkay SA. The use of virgin coconut oil-supplemented expressed breast milk in augmenting weight gain among neonates <35 weeks gestation: a pilot study. Phil Children’s Med Center J. 2006.
  21. Baluyot-Martonito MG, Ferrer J. The effect of virgin coconut oil supplementation on the nutritional status of children 7 months to 18 years old sheltered in a home care institution in Cavite. Unpublished study.
  22. Aguilar-Gonzales RA. A randomized controlled trial on the use of virgin coconut oil in augmenting weight gain among 3–6 year-old children in a daycare center at Tala, Caloocan City. Unpublished study.
  23. Aguinaldo LB. Effect of virgin coconut oil supplementation on weight and height among underweight children aged 10–14 years in a shelter in Quiapo, Manila. Unpublished study.
  24. Deasy MD, Dechangchon MV. The efficacy of virgin coconut oil in improving the nutritional status (weight and height) of children aged 1–5 years enrolled in a feeding program: a community-based, double-blind randomized controlled clinical trial. Unpublished study.
  25. Agrimano MM, Bravo LC, Gonzales ML, Maramba C, Torres ML. Effect of virgin coconut oil on weight gain among pediatric TB patients undergoing short-course chemotherapy. UP Manila J. 2011;14:Oct.
  26. Mantaring JBV, Aurelio MA, Santiago VD. Virgin coconut oil for the prevention of sepsis among preterm neonates weighing 1500 g in UP-PGH: a randomized controlled trial. UP Manila J. 2007.
  27. Dayrit CS, et al. Structured lipid of coconut and corn oil vs soybean oil in the rehabilitation of malnourished children: a field study. Phil J Intern Med. 1992;30:159–164. May–Jun.
  28. Singhania RU, Bansal A, Sharma JN. Fortified high-calorie human milk for optimal growth of low birth weight babies. J Trop Pediatr. 1989;35(2):77–78.

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