A review of the nutritional management of chyle leakage in adults

Background: Dietitians at the Oxford Radcliffe Hospital encountering the problem of chyle leakage found a lack of information regarding its dietetic management. This study was undertaken to review the literature and to survey current dietetic practice and medical opinion in the UK. Methods: A postal survey of dietitians and clinicians in relevant specialities at hospitals involved in the clinical training of dietetic students ( n =110) was undertaken. The dietitians’ questionnaire examined knowledge and experience of chyle leakage, types of patients treated, dietary therapies employed, responsibilities for prescriptions and outcomes. A different questionnaire was used to assess clinician's opinions on appropriate management. Results: A link between the origin of chyle leakage and the effectiveness of conservative management became apparent from the literature review. Conservative management appears to be most effective in chyle leakage associated with head and neck surgery, and least effective when chyle leakage is associated with malignancy. Completed questionnaires were received from 336 dietitians in 90 training departments and 132 clinicians. Dietitians reported the use of a number of dietary therapies, including low‐fat diets. These ranged from minimal long chain triglycerides (LCT) to ‘standard‘ low‐fat diets. These were sometimes used in conjunction with medium chain triglycerides (MCT). The use of total parenteral nutrition (TPN) was also reported, either alone or in combination with a ‘low‐fat diet‘. No clear pattern emerged as to when a particular therapy was indicated or should be revised. More than 70% of respondents to the medical survey considered there to be a role for conservative management in the treatment of chyle leakage. TPN appeared to be slightly favoured over minimal‐fat (LCT) diet. Dietitians are hampered by the lack of consensus about the optimum nutritional therapy for this condition. This was reflected in the wide variation in the composition of reported dietary regimens. The majority of dietitians who had treated such patients reported the use of ‘low‐fat‘ diets, but only 5 (13%) respondents specified a level of fat restriction. Conclusions : The literature suggests that TPN may be the most effective treatment for reducing chyle flow. However, given the risks of TPN an initial trial of minimal‐fat (LCT) diet plus MCT is warranted. The need for readily accessible practice guidelines for dietitians is apparent.