Cirrhosis is a liver disease that is chronic and characterized by the progressive loss of liver function. It is among the leading causes of death in the United States. The primary causes of cirrhosis are hepatitis C, a viral infection that infects that liver, and alcoholism. Genetics may also play a role in the development of liver cirrhosis. If you have cirrhosis, it is important to get enough calories to slow the progression of the disease and decrease health risks associated with cirrhosis.
Pathophysiology of Cirrhosis
In cirrhosis, blood flow to the liver is hampered because scarred tissue replaces normal, healthy tissue and prevents or obstructs the normal flow of blood to the liver. As scar tissue replaces more and more healthy liver tissue, liver function progressively decreases and liver cells die. If cirrhosis is untreated or not treated until later stages of the disease, life threatening complications occur and patients are at risk for early mortality.
Getting Enough Calories is Important
Because calorie needs increase dramatically when cirrhosis of the liver is present, consuming inadequate calories can lead to negative health consequences and spur the progressive nature of this disease. Protein calorie malnutrition, or PCM, results when patents do not have adequate protein-containing calories in their daily diets. PCM leads to loss of lean body mass and decreases survival rate. Loss of appetite is a common symptom in the cirrhotic patient, which often makes it difficult for patients to obtain adequate nutrition.
Caloric Requirements in Cirrhosis
Malnutrition is a complication of liver cirrhosis caused by deficiencies in calories and protein, and the most common complication of liver cirrhosis. Protein stores in the body must be spared to prevent further liver damage and loss of lean body mass. This is achieved by consuming 13.6 to 15.9 calories per lb. of body weight per day. Most patients need to aim for 3000 calories or more per day. High-calorie liquid nutritional supplements can help to reach this goal. If symptoms such as vomiting or diarrhea prevent adequate oral intake are present, tube-feeding directly into the gut or intravenous feeding may be required to ensure calorie needs are met.
Percent of Calories from Protein, Fat, and Carbohydrates
About 15 to percent of total calories should come from high-quality protein sources, such as eggs, fish, and poultry. Calories from fat can range from 30 to 40 percent, depending on how well it is tolerated by the cirrhotic patient. About 50 to 55 percent of calories should come from carbohydrates or at least 300 g of carbohydrates should be consumed daily. This amount is necessary to prevent the body from breaking down its own protein stores and reduce the risks of protein calorie malnutrition.
References
- "National Vital Statistics Report"; Death: Final Data for 2007; J. Xiajuin, et al; May 2010
- "Nutrition in Clinical Practice"; Nutrition in Heptatic Encphalopathy; R. Chadalavada, et al; June 2010
- "Acta Gastroenterol Belg"; Nutrition in Hepatic Encephalopathy; Rajagopal Chadalavada, M.D., et al; June 2010
- "Zeitschrift fur Gastroenterologie"; Protein Catabolism and Malnutrition in Liver Cirrhosis - Impact of Oral Nutritional Therapy; K. Norman, et al; July 2010
- "Liver International"; Protein-calorie Malnutrition as a Prognostic Indicator of Mortality Among Patients Hospitalized with Cirrhosis and Portal Hypertension; J. Sam, et al; October 2009
- "Acta Gastro-enterologica Belgica"; Cirrhosis and Malnutrition: Assessment and Management; C. Verslype, et al; October 2010
