Biliary atresia diet: Nutritional strategies for better health

Last updated June 4, 2025, by Susie Strachan
Fact-checked by Marta Figueiredo, PhD

Biliary atresia is a liver condition present from birth in which the bile ducts — the tubes that carry the digestive fluid, bile, from the liver to the intestines — are blocked or missing.

This prevents bile drainage to the intestines and hinders the digestion and absorption of fats and fat-soluble vitamins. Impaired bile flow causes the digestive fluid to accumulate to toxic levels in the liver, causing inflammation and damage.

A biliary atresia diet high in calories, easy-to-digest fats, protein, and fat-soluble vitamins can help prevent nutrient deficiencies and improve growth and other outcomes before and after biliary atresia treatments like the standard Kasai surgery.

Your child’s healthcare provider can help you develop the best nutrition plan for their biliary atresia based on their current needs.

Nutritional challenges in biliary atresia

Infants and children with biliary atresia are at risk of malnutrition due to a number of factors, including reduced food intake, fat malabsorption, and altered nutrient metabolism.

One of the biggest challenges for these children is that their bodies can’t properly digest and absorb fats, which are the main source of energy in infants.

Normally, bile flows from the liver and helps break down fats, but when it can’t reach the intestines, your child may struggle to get enough calories and nutrients, such as fat-soluble vitamins, which are important for:

vision
bone strength
immunity
blood clotting.

Children with these vitamin deficiencies may experience poor growth, weak bones, or frequent infections. This, along with eating problems, explains why some children with this type of liver disease are smaller or shorter than their peers.

Additionally, your child may need more calories and protein than usual, further contributing to a high risk of malnutrition.

Dietary concerns for individuals with biliary atresia

According to the American Liver Foundation, it’s common for infants and children diagnosed with biliary atresia to struggle with eating. They may feel nauseous, have trouble keeping food down, or notice that food doesn’t taste good.

To support your child’s nutrition, their healthcare team may recommend lifestyle modifications like adding supplements or using feeding tubes.

For example, if your child has trouble eating or is too sick to eat normally and isn’t getting enough nutrients, they may need high-calorie liquid feedings through a nasogastric tube, which is placed in the nose and guided down the esophagus and into the stomach.

If your child does not tolerate this type of feeding, they may need total parenteral nutrition, in which nutrition is given directly into the bloodstream, completely bypassing the gastrointestinal system.

Your child’s medical team will help determine the best approach to support their liver health, growth, and overall well-being.

Healthy fats and caloric intake

Children with biliary atresia experience fat malabsorption and have a faster metabolism, requiring 140% to 150% of predicted energy needs.

When focusing on fats that are easier for a child with biliary atresia to absorb, consider medium-chain triglycerides (MCTs).

MCTs are a type of fat that does not require bile for digestion. This means that they can help your child absorb fat-soluble vitamins and meet their energy needs, even with the challenges of fat malabsorption in biliary atresia.

You can get MCTs into your child’s diet using MCT oil, which is a supplement often derived from coconut or palm kernel oil.

In addition to using MCT oil for biliary atresia, a high-calorie diet can support your child’s energy needs and growth.

Some calorie-dense foods include:

whole grains
full-fat dairy products
nut butters and avocados.

Essential vitamins and supplements

Fat malabsorption in biliary atresia can result in deficiencies of fat-soluble vitamins A, D, E, and K, which are essential for various functions in your child’s body.

Vitamin A supports vision, the immune system, and reproductive health.
Vitamin D can help with optimal bone health, overall growth, and immune function.
Vitamin E helps maintain healthy skin, eyes, and the immune system.
Vitamin K supports blood clotting, bone health, and immune function.

Your child’s healthcare team may adjust supplement doses based on blood tests to correct deficiencies and avoid toxicities.

Protein and overall nutrient balance

Children with biliary atresia can experience increased breakdown of proteins, which help repair and build the body’s tissues, including muscles. This means that your child may have higher-than-normal protein needs to maintain muscle mass and repair tissues.

Incorporating protein-rich foods like lean meats, dairy products, and legumes can help. In some cases, protein supplements may be recommended.

In addition to protein, it can be helpful to maintain a balanced intake of carbohydrates and fats to meet your child’s energy requirements.

Carbohydrates such as rice, mashed potatoes, oatmeal, pasta, and soft-cooked vegetables can make up 40% to 60% of the total energy intake, providing a steady fuel source.

Hydration and fluid management

Liver dysfunction associated with biliary atresia can cause fluid imbalances, leading to symptoms such as:

a swollen belly due to the buildup of fluid in the abdomen (ascites)
swelling in the legs and other parts of the body due to fluid retention.

Hydration management can help limit these symptoms. Healthcare providers may recommend fluid management strategies, including having your child:

take medications that help remove excess fluid from the body
follow a low-sodium diet to reduce salt intake and minimize fluid retention
hydrate with water, electrolyte drinks, or breast milk/formula.

Foods to eat

When your child has biliary atresia, following a healthy liver diet can support their health. Focus on liver-friendly diet options for children that are easier to digest and provide essential nutrients.

Some of the best foods for biliary atresia can include:

MCT oils that provide a source of fats and calories without the need for bile
lean proteins such as chicken, fish, and eggs to meet the increased protein needs of children with biliary atresia and allow growth and muscle development
nutrient-dense vegetables and fruits such as sweet potatoes, avocados, carrots, and bananas, which are generally easy to digest.

High-calorie supplements or formulas may also help support a high-calorie diet for biliary atresia.

Foods to avoid

Certain foods can be more challenging for your child’s body to process when dealing with biliary atresia. Avoiding these can help reduce digestive strain and support liver health.

High-fat foods such as fried foods and fatty meats can put added strain on the liver, as they increase bile production for their digestion.
Processed foods with preservatives, artificial colors, or other additives can also put unnecessary stress on the liver.
Sugar-heavy foods such as sugary drinks and desserts can lead to fat buildup in the liver, causing further damage to the organ, while not providing essential nutrients.
High-sodium foods like processed meats and packaged foods can promote swelling and fluid buildup.

Special considerations

Managing nutrition for children with biliary atresia can be complex, as their needs may change throughout their treatment, especially if they have undergone a Kasai procedure or liver transplant.

Kasai procedure

The Kasai procedure is used to restore bile flow and slow down liver damage. This surgery creates a new pathway for bile to flow from the liver into the intestines, taking over the job of the blocked or missing bile ducts.

While this surgery can help improve digestion, some children may still have trouble absorbing fats and fat-soluble vitamins. A post-Kasai procedure diet may continue to include MCTs and vitamin supplements to support calorie intake and reduce the risk of malnutrition.

Liver transplant

Many children with biliary atresia will eventually need a liver transplant, with more than half requiring one by age 10 and around 80% needing one before they turn 20.

After a liver transplant, your child will likely be able to enjoy a healthy, balanced diet that’s appropriate for their age and no longer need MCTs or fat-soluble vitamin supplements. They may also experience catch-up growth after the transplant.

However, there can be an increased risk of foodborne illness due to standard treatment with immune system suppressants to avoid transplanted liver rejection, so follow food safety guidelines when preparing meals.

Practical tips for parents and caregivers

Adjusting your child’s diet as needed, based on growth patterns and lab results, can help reduce the risk of nutrient and growth deficiencies, including after procedures like the Kasai surgery or a liver transplant.

Feeding tips for biliary atresia that can help make digestion easier include:

serving smaller portions more frequently throughout the day instead of larger meals
cooking, mashing, or pureeing vegetables and fruits until soft to make them easier to digest
mixing MCT supplements into water, milk, breast milk, formula, fruit juice, soup, applesauce, or yogurt
choosing simple, easy-to-digest carbohydrates like rice, oats, or mashed potatoes.

Regular checkups with your healthcare team can help track your child’s growth and nutritional status and help you choose the most nutritious diet.

Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.