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Nutrition in Chronic Liver Disease

by Paula Cox, RN

The liver is the site of an astonishing array of biochemical pathways responsible for the production and utilization of nutrients and other chemicals. It plays a central role in carbohydrate, lipid and nitrogen metabolism, and it is one of the key organs that incorporate nutrients in the body cell mass. Although the normal liver has a tremendous functional reserve and considerable ability to regenerate, in all patients with serious illness appropriate measures to avoid deficiencies and treat these deficiencies should be instituted without delay. Severe protein-calorie malnutrition is common in patients with advanced liver disease and those receiving treatment for their liver disease. In these patients we see disturbances of carbohydrates, protein and lipid metabolism as well as caloric intake and vitamin malabsorptions. For a patient that has compensated liver disease, a normal diet can be used. It should be vitamin and mineral enriched, with no megadosing of vitamins especially Vitamin A which is known to be hepatotoxic. The diet should contain normal amounts of protein which is a minimum of 1.0-1.3 grams/kg and fat. Patients should be careful whenever using any types of herbal treatments or supplements as many of those are also liver toxic.

In the decompensated patient malnutrition can be more of a challenge and require therapeutic dietetic interventions. Protein intake for these individuals should continue to be at 1.0-1.3 grams/kg with the use of lactulose to help control encephalopathy. There is no fat restriction and sodium should be at about 2gm or less, and fluid restriction should occur only when serum sodium falls below 120-125mmols/liter or clinical condition warrants it. The third group of patients are those that are being treated with interferon. These patients often have nausea, vomiting, or anorexia which puts them at risk for malnutrition. We know that interferon causes a cascade effect which causes protein breakdown and muscle wasting which these patients are often effected with. In these patients a diet enriched in protein and calories is essential. Often the use of dietary supplements such as Ensure or Instant Breakfast and small frequent feedings with bland non nauseating foods like crackers, rice, toast and baked potatoes are often beneficial. Also be cause of the drying effects of interferon patients should be encouraged to drink large amounts of water while on treatment, a minimum of 2 liters a day. This does not include caffeinated beverages which act like diuretics,for every caffeinated beverage they must drink one extra 8oz glass of water. In all 3 groups of patients it is very important to remind them that they should not consume any alcoholic beverages.

In summary, good nutrition - a balanced diet with adequate calories, proteins, fats and carbohydrates can actually help the damaged liver to regenerate new liver cells . Regardless of the stage of liver disease, early nutrition assessment and dietetic interventions are key in helping to provide the optimum success with these patients.

Hepatology 1994;19:518-533
Topics in Clinical Nutrition Jan 1997;17-20


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