Biliary atresia (BA) is an obliterative cholangiopathy that manifests in early infancy, negatively affecting nutritional status, growth, and development [1]. The most accepted treatment for BA is an early Kasai portoenterostomy (KPE) performed before two months of age, with presentation after three months considered late [2], [3]. Liver transplantation is the second option, and BA is the most common reason for this procedure in paediatrics [2].

The pathogenesis of growth failure and malnutrition in this group of infants and children is multifactorial. Poor bile flow reduces the delivery of bile acids to the small intestine, leading to decreased mixed micelle formation and inevitable fat and malabsorption of fat-soluble vitamins (A, D, E, and K) [4]. Like other patients with cholestasis, most of the calories lost in stool are unabsorbed fats [5]. Medium-chain triglycerides (MCTs) do not require emulsification with bile and can, therefore, be absorbed directly into the portal venous system. Nutritional support and diet supplementation with MCTs improve the growth of these children [6].

From the nutritionist's standpoint, a single height measurement identifies only unusually short children whose height centile falls outside the cut-off point of −2SD. Poor height velocity is crucial for diagnosing growth retardation and is detected through serial measurements of length and height, representing the increase in height over at least six months [7]. The 2019 joint position paper released by the joint North American and European Societies of Paediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN/ESPGHAN) favoured the use of measurements such as length/height, triceps skinfold thickness (TSF), and midarm circumference (MAC) over bodyweight for nutritional assessment and follow-up in children with chronic liver disease [8]. TSF and MAC are sensitive to even small nutritional status changes and unaffected by ascites or organomegaly. Growth assessment with a frequency ranging from every two weeks to three months is advocated.

The present study analyzed the effectiveness of nutritional counselling using medium-chain triglyceride (MCT) formulas and appropriate supplementation on the nutritional status, growth patterns, and vitamin D levels of Kasai-operated patients with biliary atresia.