A healthy liver performs over 500 metabolic functions. It regulates the metabolism of protein, fats, carbohydrates, vitamins, and minerals. Malnutrition is common in end stage liver disease (ESLD). Once the liver is damaged, symptoms include fatigue, loss of appetite, nausea, abdominal pain, ascites, or accumulation of fluid in the abdominal cavity, altered nutritional metabolism, impaired digestion and absorption. Malabsorption of vitamins and minerals also occurs.
Protein Intake
If ammonia levels are high, protein intake must be only 0.60 g per day. This would include one 3-oz. meat patty, two glasses of milk, two pieces of fruit, two servings of vegetables, and 10 oz. of rice or pasta per day. If the patient has a normal ammonia level, he can consume higher amounts of protein. Some people drink nutritional drinks for calories, protein and flavor rather than eat meals.
Calories and Carbohydrates
Persons with ESLD need more calories than a well person. Carbohydrate provides an excellent source of energy. A stable person with ESLD needs 120 percent more energy than normal needs, while a person with ESLD and an infection or ascites needs 150 percent more energy than normal. Carbohydrate sources include pasta, rice, potatoes, fruits, vegetables, yogurt, breads and cereals. Nutritional drinks or snacks should be eaten often to help maintain weight and overall health. Sometimes a feeding tube is necessary to provide nutrition.
Fatty Liver
Fatty liver occurs before ESLD. The liver moves fatty acids from the adipose tissue, or fat stores, to the liver and the liver makes more fats. Sometimes, a patient has to drink medium-chain triglyceride oil if she is having excessive diarrhea, which is typically caused by malabsorption of fats. A patient may also need to restrict fatty food intake such as fried foods, salad dressings, margarine, and butter.
Vitamins and Minerals
Supplementation of vitamins and minerals with ESLD is necessary since the liver is not absorbing all the nutrients. Vitamins and minerals that specifically need supplementation include vitamins D, E, K, A, niacin, thiamine, B-6, B-12, zinc, selenium, magnesium, phosphorus, and potassium. A patient with ESLD should stop drinking alcohol, eat well, take supplements if prescribed, take vitamins and minerals and follow a doctor's advice on the amount of protein she should consume each day.
References
- "Krause's Food and Nutrition & Diet Therapy"; L. K. Mahan and Sylvia Escott Stump; 2000
- Malnutrition in Liver Disease -- Pathophysiology -- Algorithm; John Anderson, Ph.D. and Sndford C Garner, Ph.D.; 2000.
- "British Journal of Nutrition"; Long-term oral re-feeing of patiens with cirrhosis at the liver; Nielsen K, et al.; 1995
