Medium-chain triglycerides (MCTs, C6–C12 fatty acids) exhibit rapid absorption, preferential portal transport, efficient mitochondrial β-oxidation, promoting acetyl-CoA formation and ketogenesis. Under high lipid flux or impaired β-oxidation, MCTs undergo ω-oxidation, producing dicarboxylic acids further metabolized peroxisomally, preventing fatty acid accumulation. Industrially, MCTs are synthesized via chemical or enzymatic esterification of caprylic (C8) and capric (C10) acids, yielding high-purity triglycerides used in food and medical nutrition. In Germany and across the European Union, they are primarily used in Foods for Special Medical Purposes (FSMPs) for conditions such as fat malabsorption, ketogenic dietary therapy for refractory epilepsy, and inherited disorders of long-chain fatty-acid oxidation. In Japan, MCTs are additionally incorporated into functional food systems, including Foods for Specified Health Uses (FOSHU) and Foods with Function Claims (FFC), targeting generally healthy adults and older populations. In the United States, MCTs are widely marketed as food ingredients, dietary supplements, clinical nutrition products, and medical foods, reflecting their status as generally recognized as safe (GRAS). This review integrates knowledge on MCT metabolism, industrial production, clinical applications, and regulatory frameworks in Germany, Japan, and the United States, highlighting how regulatory environments influence the translation of MCTs from clinical nutrition toward broader preventive health strategies.